What is the life expectancy of a 90-year-old woman with lung cancer and malignant pleural effusion, managed with an indwelling pleural catheter (IPC), given her otherwise good health?

From the Guidelines

The life expectancy of a 90-year-old woman with lung cancer and malignant pleural effusion managed with an indwelling pleural catheter (IPC) is likely between 3-6 months, though individual cases may vary. This estimate reflects the advanced nature of her disease, as malignant pleural effusion typically indicates stage IV lung cancer, which carries a poor prognosis even with treatment 1. Despite her otherwise good health, her advanced age compounds the challenge of surviving metastatic disease. The IPC provides symptomatic relief from fluid accumulation but does not significantly extend survival. Factors that might influence her specific prognosis include the histological type of lung cancer, presence of actionable genetic mutations, response to any systemic therapies, functional status, and how well she tolerates drainage procedures.

Key Considerations

• The presence of malignant pleural effusion usually represents advanced or metastatic disease, and consequently survival is poor, ranging from a median of 3 months to 12 months depending on underlying patient and tumour factors 1.
• The median survival after the diagnosis of MPE is 4 to 6 months, depending on the type of neoplasm 1.
• The IPC is an effective option for controlling recurrent malignant effusions when length of hospitalisation is to be kept to a minimum and expertise and facilities exist for outpatient management of these catheters 1.
• A systematic review of 12 observational studies on TPC for palliation of malignant effusions found that 96% of patients derived symptomatic relief, with a reported rate of pleurodesis of 46% 1.

Management and Prognosis

The management of malignant pleural effusions focuses on relieving symptoms, with the IPC being a viable option for patients with recurrent effusions. While the IPC can provide symptomatic relief, it is essential to consider the patient's overall prognosis and quality of life. Palliative care should be integrated into her management plan to maximize quality of life during her remaining time. The patient's advanced age and the presence of metastatic disease are significant factors influencing her prognosis, and individual cases may vary. However, based on the available evidence, a life expectancy of 3-6 months is a reasonable estimate 1.

From the Research

Life Expectancy of a 90-Year-Old Woman with Lung Cancer and Malignant Pleural Effusion

• The life expectancy of a 90-year-old woman with lung cancer and malignant pleural effusion is generally poor, with a median survival time of approximately 20 weeks 2.
• A study published in 2009 reported 30-day and 1-year mortality rates of 12.8% and 83.6%, respectively, in patients with malignant pleural effusion 2.
• The use of an indwelling pleural catheter (IPC) can provide palliative relief and improve quality of life in patients with malignant pleural effusion, but it does not significantly impact life expectancy 3, 4.

Management of Malignant Pleural Effusion with Indwelling Pleural Catheter

• The management of malignant pleural effusion with an IPC can provide significant symptom relief and improve quality of life in patients with advanced malignancies 3, 4.
• A study published in 2005 reported that 70-80% of patients experienced uncomplicated catheter use and significant symptom relief, with a mean duration of catheter use of 2.3 months 3.
• Another study published in 2014 reported that IPC use was associated with significant improvements in symptoms and quality of life in patients with malignant pleural effusion, particularly in those with lung cancer 4.

Prognosis and Survival

• The prognosis for patients with malignant pleural effusion is generally poor, with an average survival of 4-9 months from diagnosis 5.
• The presence of malignant pleural effusion is associated with high morbidity and mortality, and the underlying disease and extent of primary tumor are key factors in determining prognosis 5.
• A study published in 2009 reported that malignant pleural effusion portends a dismal prognosis of less than 6-month longevity, with the exception of breast and ovarian cancer 6.