Optimal Paracentesis Volume for Terminally Ill Cancer Patients With Ascites

Tetsuya Ito; Naosuke Yokomichi; Hiroto Ishiki; Takashi Kawaguchi; Ken Masuda; Hiroaki Tsukuura; Hiromi Funaki; Kozue Suzuki; Kiyofumi Oya; Jun Nakagawa; Masanori Mori; Takuhiro Yamaguchi

doi:10.1016/j.jpainsymman.2021.04.010

Optimal Paracentesis Volume for Terminally Ill Cancer Patients With Ascites

J Pain Symptom Manage. 2021 Nov;62(5):968-977. doi: 10.1016/j.jpainsymman.2021.04.010. Epub 2021 Apr 29.

Authors

Affiliations

¹ Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan; Department of Palliative Medicine and Advanced Clinical Oncology, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan.
² Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Japan. Electronic address: n-yokomichi@sis.seirei.or.jp.
³ Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.
⁴ Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan.
⁵ Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁶ Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan.
⁷ Department of Palliative Care, Hiroshima Prefectural Hospital, Hiroshima, Japan.
⁸ Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious disease Center Komagome Hospital, Tokyo, Japan.
⁹ Department of Transitional and Palliative Care, Iizuka Hospital, Fukuoka, Japan.
¹⁰ Hospice, The Japan Baptist Hospital, Kyoto, Japan.
¹¹ Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Shizuoka, Japan.
¹² Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan.

PMID: 33933616
DOI: 10.1016/j.jpainsymman.2021.04.010

Abstract

Context: Patients with malignant ascites often suffer from distressing symptoms, especially in their end-of-life stage. Although paracentesis is the most common treatment modality to alleviate such symptoms, the optimal volume of paracentesis is not known.

Objectives: To explore the efficacy and safety of paracentesis by the drainage volume for terminally ill cancer patients with malignant ascites.

Methods: This was part of a multicenter prospective observational study (EASED study). Consecutive adult patients with advanced cancer admitted to 23 participating palliative care units were eligible. We analyzed patients with malignant ascites who received paracentesis. We compared paracentesis-free survival (PFS) using Cox regression among three groups with different paracentesis volumes: minimum: ≤ 1500 mL, small: 1500-2500 mL, and moderate: > 2500 mL. Trends of the difference in the numerical rating scale of abdominal distension (0-10) and adverse events were compared among the 3 groups.

Results: Of the 1926 patients enrolled, 673 developed ascites (symptomatic, n = 374 and asymptomatic, n = 299). Finally, we analyzed 87 patients with paracentesis. Median PFS was 7 days. Compared with a moderate volume, small-volume paracentesis was not a significant risk for shorter PFS (HR: 1.14, 95% CI: 0.69-1.93), while a minimum volume was a significant risk (HR: 2.34). The abdominal distension intensity significantly decreased after paracentesis (median: 7.5 to 4.0), while the difference did not significantly increase as the volume of paracentesis rose (P = 0.61). No severe adverse event was observed.

Conclusion: Even small-volume paracentesis could alleviate abdominal distension of terminally ill cancer patients with malignant ascites without shortening the paracentesis interval compared with moderate-volume paracentesis. Small-volume paracentesis was a well-balanced treatment for these patients.

Keywords: Malignant ascites; advanced cancer; paracentesis.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Ascites / etiology
Ascites / therapy
Humans
Palliative Care
Paracentesis*
Peritoneal Neoplasms*
Terminally Ill