Heterogeneous delivery of definitive interventions in malignant pleural effusions – results from a Danish survey

Background: Malignant pleural effusion (MPE) is common with an annual incidence of around 5000 cases in Denmark. Danish health-care is free for all citizens as it is fully financed by the government. MPE is associated with short survival and high disease burden. There is solid evidence for reduced symptom burden and hospital use by definitive pleural procedures: indwelling pleural catheders (IPC) or pleuradesis. Difficult access to definitive pleural procedures is associated with reduced use. We aimed at investigating national differences in delivery of this care. Materials and Methods: An anonymous, one-page, multiple choice paper survey on delivered pleural service completed by pulmonologists at the annual conference in the Danish Respiratory Society, 23 November 2018. Results: Responses from delegates representing the ten largest departments of respiratory medicine (and all five regions of Denmark) were collected. IPC service were available in eight and pleuradesis in six centres. All centres had implemented ultrasound-based pleural techniques, and five had a training program for pleural interventions. In a few centres, IPC were administered by non-pulmonologists (radiologists, anesthesiologists) without a supporting pleural service. Conclusion: Access to definitive interventions for MPE is highly heterogeneous and therefore a common challenge for patients and clinicians. There is an imminent need for improved collaboration between oncologists and pulmonologists to provide evidence-based care to patients with MPE. National differences in health-care organisation may hamper external validity.