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Asked the question that matters to someone with months to live, how many days will I spend in hospital, and found the home drain wins by about three.
AMPLE recruited from nine centres in Australia, New Zealand, Singapore and Hong Kong between July 2012 and October 2014 and randomised 146 patients with symptomatic malignant pleural effusion to an indwelling pleural catheter (74) or talc pleurodesis (72), minimised by malignancy (mesothelioma against others) and trapped lung, stratified by region and followed for twelve months. Two withdrew before the intervention. Median age was 70.5 years and 56.2 percent were male.
The catheter group spent significantly fewer days in hospital: median 10.0 days (interquartile range 3 to 17) against 12.0 (7 to 21), p=0.03, Hodges-Lehmann estimate of difference 2.92 days (95 percent confidence interval 0.43 to 5.84). Breathlessness and quality of life did not differ.
Together with TIME2, AMPLE settled the argument: neither method controls symptoms better, so the choice turns on how much hospital time a patient is willing to spend, whether the lung re-expands, and whether there is someone at home able to drain the catheter. A patient with a trapped lung cannot be pleurodesed at all and needs the catheter.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
146 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Total days in hospital to death or 12 months (median)primary | Indwelling pleural catheter | 74 | 10 days | - | 0.03 | link |
| Talc pleurodesis | 72 | 12 days |
Shares Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain, Palliative, Lung cancer (all types), Small-cell lung cancer.
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