Publications by authors named "Matthew Evison"

58 Publications

The DIAMORFOSIS (DIAgnosis and Management Of lung canceR and FibrOSIS) survey: international survey and call for consensus.

ERJ Open Res 2021 Jan 25;7(1). Epub 2021 Jan 25.

First Academic Dept of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Background: Currently there is major lack of agreement on the diagnostic and therapeutic management of patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. Our aim was to identify variations in diagnostic and management strategies across different institutions and provide rationale for a consensus statement on this issue.

Methods: This was a joint-survey by European Respiratory Society (ERS) Assemblies 8, 11 and 12. The survey consisted of 25 questions.

Results: Four hundred and ninety-four (n=494) physicians from 68 different countries and five continents responded to the survey. Ninety-four per cent of participants were pulmonologists, 1.8% thoracic surgeons and 1.9% oncologists; 97.7% were involved in multidisciplinary team approaches on diagnosis and management. Regular low-dose high-resolution computed tomography (HRCT) scan was used by 49.5% of the respondents to screen for lung cancer in IPF. Positron emission tomography (PET) scan and endobronchial ultrasound (EBUS) is performed by 60% and 88% to diagnose nodular lesions with mediastinal lymphadenopathy in patients with advanced and mild IPF, respectively. Eighty-three per cent of respondents continue anti-fibrotics following lung cancer diagnosis; safety precautions during surgical interventions including low tidal volume are applied by 67%. Stereotactic radiotherapy is used to treat patients with advanced IPF (diffusing capacity of the lung for carbon monoxide () <35%) and otherwise operable nonsmall cell lung cancer (NSCLC) by 54% of respondents and doublet platinum regimens and immunotherapy for metastatic disease by 25% and 31.9%, respectively. Almost all participants (93%) replied that a consensus statement for the management of these patients is highly warranted.

Conclusion: The diagnosis and management of IPF-lung cancer (LC) is heterogeneous with most respondents calling for a consensus statement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00529-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837280PMC
January 2021

The current treatment landscape in the UK for stage III NSCLC.

Authors:
Matthew Evison

Br J Cancer 2020 12;123(Suppl 1):3-9

North West Lung Centre Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

For stage III non-small cell lung cancer (NSCLC), approximately a third of patients survive up to 5 years, with decreasing 5-year survival rates for stage IIIB and stage IIIC disease. Although curable, stage III NSCLC encompasses a diverse range of disease presentation, with an equally complex range of multi-modal treatment options, including systemic and local therapies for distant and local disease control, respectively. This complexity results in a number of challenges for the multi-disciplinary team (MDT) in achieving optimal treatment outcomes for patients. As multi-modality treatment is the preferred treatment strategy for all stage III disease, the focus of this article is the key surgical, chemotherapy and radiotherapy clinical trials as well as guidelines that currently outline radical therapy options for patients with both potentially resectable and unresectable stage III NSCLC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41416-020-01069-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735211PMC
December 2020

Homozygous deletion of CDKN2A in malignant mesothelioma: Diagnostic utility, patient characteristics and survival in a UK mesothelioma centre.

Lung Cancer 2020 12 5;150:195-200. Epub 2020 Nov 5.

Pleural Medicine, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. Electronic address:

Background: Detection of homozygous deletion of the p16 gene (CDKN2A) by fluorescence in situ hybridization (FISH) has been investigated as an ancillary technique in the diagnosis of malignant mesothelioma.

Method: This retrospective study reviewed the results of all p16 FISH tests performed at a regional mesothelioma centre from February 2012 to November 2019 in cases of possible mesothelioma to examine the diagnostic utility of this test as well as patients characteristics and survival in p16 FISH positive mesothelioma versus p16 FISH negative mesothelioma.

Results: P16 FISH testing was requested in 216 pathological samples in the study period. The test failure rate was 4% (10/216). Median time from request to result was 10 days (IQR 7-13, range 1-30). The sensitivity, specificity, NPV and PPV were 60 %, 100 %, 39 % and 100 % respectively. There were no false positive results and this genetic aberration was only detected in cases of mesothelioma. The prevalence of p16 FISH positive mesothelioma was higher in cytological specimens compared to histological specimens (75 % vs 58 %, p = 0.03) and lower in women compared to men (33 % vs 66 %, p = 0.003). P16 FISH positive mesothelioma was associated with significantly worse survival (median overall survival 285 vs 339 days, p = 0.0018). This remained significant after adjusting for confounding variables (OR 4.4, 95 %CI 1.84-11.14, p = 0.001).

Conclusions: In this study, 60 % of mesotheliomas harbour a homozygous deletion of CDKN2A and can be accurately, reliably and efficiently identified by p16 FISH testing. This test can be embedded within routine practice in mesothelioma pathways to enhance diagnostic accuracy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lungcan.2020.10.020DOI Listing
December 2020

Pulmonary passport: a service evaluation study of a standardised web-based procedure logbook to aid specialist respiratory training and appraisal.

BMJ Open Respir Res 2020 11;7(1)

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK

Introduction: The pulmonary passport (PP) is a secure web-based procedural logbook for specialist respiratory trainees with enhanced functionality that includes automated analysis to provide key performance metrics and in-platform interactions with supervisors.

Methods: This service evaluation study used preimplementation and postimplementation online surveys in both trainees and supervisors along with analysis of recorded data within the PP to evaluate the impact of this service on data capture, training, appraisal and quality assurance.

Results: From August 2017 to August 2019, 69/73 (95%) specialist respiratory trainees eligible to use the PP across two UK health education deaneries registered with the system and logged 7352 procedures. 3105 thoracic ultrasound procedures identified 2145 pleural effusions and resulted in 1253 pleural procedures of which 96% were successful. 4% of ultrasounds required referral to a more expert sonographer. Iatrogenic bleeding and pneumothorax both occurred in ≤1% of all pleural procedures. 1909 basic diagnostic bronchoscopies were recorded including 1236 bronchial washes, 328 brushes and 221 endobronchial biopsies where definite tumour was identified (biopsy sensitivity 74%). Preimplementation and postimplementation survey data confirmed the PP had increased the consistency of logging procedures by trainees, the depth of data captured, the review of procedural performance metrics in appraisal and the frequency of formal supervisor feedback.

Discussion: In this regional project, the implementation of a web-based procedural logbook has been feasible with excellent uptake and has enhanced procedural recording, supervision and appraisal. Furthermore, it provides unprecedented quality assurance at an individual trainee, trust and deanery level and has a number of potential wider applications in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjresp-2020-000690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662433PMC
November 2020

European Respiratory Society statement on thoracic ultrasound.

Eur Respir J 2021 Mar 4;57(3). Epub 2021 Mar 4.

Academic Respiratory Unit, University of Bristol, Bristol, UK.

Thoracic ultrasound is increasingly considered to be an essential tool for the pulmonologist. It is used in diverse clinical scenarios, including as an adjunct to clinical decision making for diagnosis, a real-time guide to procedures and a predictor or measurement of treatment response. The aim of this European Respiratory Society task force was to produce a statement on thoracic ultrasound for pulmonologists using thoracic ultrasound within the field of respiratory medicine. The multidisciplinary panel performed a review of the literature, addressing major areas of thoracic ultrasound practice and application. The selected major areas include equipment and technique, assessment of the chest wall, parietal pleura, pleural effusion, pneumothorax, interstitial syndrome, lung consolidation, diaphragm assessment, intervention guidance, training and the patient perspective. Despite the growing evidence supporting the use of thoracic ultrasound, the published literature still contains a paucity of data in some important fields. Key research questions for each of the major areas were identified, which serve to facilitate future multicentre collaborations and research to further consolidate an evidence-based use of thoracic ultrasound, for the benefit of the many patients being exposed to clinicians using thoracic ultrasound.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.01519-2020DOI Listing
March 2021

Implementation and outcomes of the RAPID programme: Addressing the front end of the lung cancer pathway in Manchester.

Clin Med (Lond) 2020 07;20(4):401-405

Wythenshawe Hospital, Manchester, UK.

Introduction: Patients with suspected lung cancer require computed tomography (CT), specialist interpretation of the CT and a consultation with a specialist. Significant time savings could be made with rapid access to these components in the front end of the lung cancer pathway.

Methods: The RAPID programme was launched at Manchester's Wythenshawe Hospital in April 2016. This pathway offers next working day CT for patients with suspected lung cancer, immediate 'hot' reporting of CT images and a same day consultation with a diagnostic specialist.

Results: From April 2016 to January 2019, 1,027 patients were referred to the RAPID programme. The median time from referral to CT was 3 days. The CT was hot reported in 94% of patients. The median time from CT to triage and consultation with a diagnostic specialist was 0 days. Overall 56% and 90% of patients had completed a CT and consultation within 3 and 7 days of referral, respectively (0% and 24% prior to implementation).

Conclusion: Through simple reorganisation of workload, we have significantly reduced the pathway for patients with suspected lung cancer to meet a specialist with a reported CT, something we firmly believe is replicable across all hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/clinmed.2019-0218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385808PMC
July 2020

Analysis of lung cancer risk model (PLCO and LLP) performance in a community-based lung cancer screening programme.

Thorax 2020 08 6;75(8):661-668. Epub 2020 Jul 6.

Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK

Introduction: Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCO and Liverpool Lung Project model (LLP)) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme.

Methods: Ever-smokers aged 55-74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCO score ≥1.51%) were offered annual LDCT screening over two rounds. LLP score was calculated but not used for screening selection; ≥2.5% and ≥5% thresholds were used for analysis.

Results: PLCO ≥1.51% selected 56% (n=1429) of LHC attendees for screening. LLP ≥2.5% also selected 56% (n=1430) whereas NLST (47%, n=1188) and LLP ≥5% (33%, n=826) selected fewer. Over two screening rounds 62 individuals were diagnosed with LC; representing 87% (n=62/71) of 6-year incidence predicted by mean PLCO score (5.0%). 26% (n=16/62) of individuals with LC were not eligible for screening using LLP ≥5%, 18% (n=11/62) with NLST criteria and 7% (n=5/62) with LLP ≥2.5%. NLST eligible Manchester attendees had 2.5 times the LC detection rate than NLST participants after two annual screens (≈4.3% (n=51/1188) vs 1.7% (n=438/26 309); p<0.0001). Adverse measures of health, including airflow obstruction, respiratory symptoms and cardiovascular disease, were positively correlated with LC risk. Coronary artery calcification was predictive of LC (OR 2.50, 95% CI 1.11 to 5.64; p=0.028).

Conclusion: Prospective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCO model may underestimate risk in deprived UK populations; further research focused on model calibration is required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2020-214626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402560PMC
August 2020

SABRTooth: a randomised controlled feasibility study of stereotactic ablative radiotherapy (SABR) with surgery in patients with peripheral stage I nonsmall cell lung cancer considered to be at higher risk of complications from surgical resection.

Eur Respir J 2020 11 12;56(5). Epub 2020 Nov 12.

Leeds Cancer Centre, St James's University Hospital, Leeds, UK.

Objectives: Stereotactic ablative radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I nonsmall cell lung cancer (NSCLC). Previous nonrandomised evidence supports SABR as an alternative to surgery, but high-quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establish whether a UK phase III RCT was feasible.

Design And Methods: SABRTooth was a UK multicentre randomised controlled feasibility study targeting patients with peripheral stage I NSCLC considered to be at higher risk of surgical complications. 54 patients were planned to be randomised 1:1 to SABR or surgery. The primary outcome was monthly average recruitment rates.

Results: Between July 2015 and January 2017, 318 patients were considered for the study and 205 (64.5%) were deemed ineligible. Out of 106 (33.3%) assessed as eligible, 24 (22.6%) patients were randomised to SABR (n=14) or surgery (n=10). A key theme for nonparticipation was treatment preference, with 43 (41%) preferring nonsurgical treatment and 19 (18%) preferring surgery. The average monthly recruitment rate was 1.7 patients against a target of three. 15 patients underwent their allocated treatment: SABR n=12, surgery n=3.

Conclusions: We conclude that a phase III RCT randomising higher risk patients between SABR and surgery is not feasible in the National Health Service. Patients have pre-existing treatment preferences, which was a barrier to recruitment. A significant proportion of patients randomised to the surgical group declined and chose SABR. SABR remains an alternative to surgery and novel study approaches are needed to define which patients benefit from a nonsurgical approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/13993003.00118-2020DOI Listing
November 2020

Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD.

Thorax 2020 08 22;75(8):655-660. Epub 2020 May 22.

Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

Background: COPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.

Methods: Ever smokers, age 55-74, resident in three deprived areas of Manchester were invited to a 'Lung Health Check' (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCO)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCO ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.

Results: 99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (OR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV/FVC ratio (<0.0001) and being asymptomatic (OR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (OR 2.80, 95% CI 1.60 to 8.42; p=0.002).

Conclusions: Incorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2019-213584DOI Listing
August 2020

Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'.

Eur J Surg Oncol 2021 Mar 1;47(3 Pt A):524-532. Epub 2020 May 1.

UK Active Research Institute and Solent University, UK.

Patients undergoing major cancer interventions such as major surgical resection, chemotherapy, radiotherapy, and immunotherapy are prone to the adverse effects of their cancer, as well as to the side effects of the treatments designed to cure them. The Prehabilitation process supports cancer patients in preparing for the physiological challenges of their cancer treatments, whilst aiming to shorten recovery time, reduce peri-operative complications and improve compliance with non-surgical treatments. Prehabilitation will be most useful in older patients. Greater Manchester Integrated Care system is the first regional system in the UK to introduce delivery of system-wide, large scale physical activity supported multi-modal prehabilitation and recovery programme, Prehab4Cancer as a standard of care for cancer patients. It builds upon the successful implementation of Enhanced Recovery After Surgery + programme to improve surgical care in Greater Manchester. During this review we describe the journey to develop a system wide prehabilitation model for patients with cancer. Prehab4Cancer to date has focused on robust co-design, development, and implementation of an effective service model with attention paid to stakeholder engagement. This has led to receipt of high numbers of referrals from across Greater Manchester for the all the cancer groups involved. The successful implementation of the P4C pathway in GM presents a best practice model that might be adopted by other local and combined authority areas nationally.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejso.2020.04.042DOI Listing
March 2021

British Thoracic Society Training Standards for Thoracic Ultrasound (TUS).

BMJ Open Respir Res 2020 05;7(1)

Respiratory Medicine, Royal Berkshire Hospital, Reading, Reading, UK

Introduction: The British Thoracic Society (BTS) responded to a call from the pleural community to establish this new Training Standard to detail the capabilities in practice for thoracic ultrasound (TUS), which will build on the previous curricula and extend the remit to include training for the emergency provision of TUS.

Methods: BTS convened a working group to produce a set of Training Standards.

Results: This document provides a comprehensive Training Standard for TUS facilitating timely and improved management of patients with respiratory presentations, particularly (but not exclusively) pleural pathologies.

Discussion: The Training Standards document will be widely disseminated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjresp-2019-000552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245450PMC
May 2020

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for PD-L1 Testing in Non-small Cell Lung Cancer.

Chest 2020 Sep 16;158(3):1230-1239. Epub 2020 May 16.

Lungs for Living Research Centre, UCL Respiratory, University College London, London, England; Department of Thoracic Medicine, University College London Hospital, London, England.

Background: Programmed death-ligand 1 (PD-L1) expression on cancer cells is a clinically important biomarker to select patients with non-small cell lung cancer (NSCLC) for treatment with programmed death-1/PD-L1 inhibitors. Clinical trials of immunotherapy in patients with NSCLC have required histologic evidence for PD-L1 testing; in clinical practice, cytologic samples commonly are acquired in patients with advanced disease.

Research Question: This study aims to investigate whether endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples are adequate for PD-L1 testing in NSCLC.

Study Design And Methods: This study investigates the sampling adequacy of EBUS-TBNA for PD-L1 testing when compared with other methods. Furthermore, the relationship between clinicopathologic characteristics and PD-L1 expression in the study population have been examined. Five hundred seventy-seven NSCLC specimens were analyzed from consecutive patients with NSCLC across six centers in the United Kingdom and one center in the United States between January 2015 and December 2016.

Results: In the EBUS-TBNA group (189 specimens), the overall percentage of patients with successful PD-L1 testing was 94.7%. There was no significant difference in sampling adequacy with other methods of tissue acquisition. Older patients had higher failure rates of PD-L1 testing (OR, 1.06; P = .008). In multivariate analysis, advanced N-stage (P = .048) and presence of brain metastasis (P < .001) were associated with high PD-L1 expression.

Interpretation: This large multicenter study shows that EBUS-TBNA provides samples adequate for PD-L1 testing and that advanced N stage and the presence of brain metastasis are associated with high PD-L1 expression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.chest.2020.04.059DOI Listing
September 2020

The prognostic effect of TTF-1 expression in the Chinese population of patients with advanced lung adenocarcinomas.

Transl Lung Cancer Res 2020 Feb;9(1):82-89

North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

Background: Thyroid transcription factor 1 (TTF-1), which is usually expressed by lung adenocarcinomas and small cell carcinomas, is usually used to distinguish adenocarcinoma and small cell carcinoma from cells of another type of lung cancer. We examined the association between TTF-1 expression and overall survival between patients with stage IV pulmonary adenocarcinoma to investigate the role of TTF-1 as a predictive and/or prognostic tumor marker in patients with advanced lung adenocarcinomas.

Methods: Analysis of the clinicopathologic features, treatment regimens, and overall survival of 209 lung adenocarcinoma patients who had been detected for TTF-1 expression and received consecutive treatments in the Affiliated Hospital of Qingdao University.

Results: TTF-1 expression was positive in 166 (79%) and negative in 43 (21%) patients who were reviewed. Moreover, there was no significant difference between the clinicopathologic features of TTF-1 positive and TTF-1 negative tumors. In the multivariable review, the overall survival of TTF-1 positive tumor patients was significantly longer than that of TTF-1 negative tumor patients [22.7 . 11.8 months (P<0.0001)], increasing the prognostic effect of Karnofsky performance status and receiving first-line chemotherapy or targeted therapy. Positive TTF-1 and negative TTF-1 patients receiving pemetrexed-based chemotherapy improved the duration of treatment compared to those receiving non-pemetrexed chemotherapy.

Conclusions: TTF-1 expression was associated with an improved survival in patients with advanced lung adenocarcinomas. Both patients, either TTF-1 positive or negative, could benefit from the first-line chemotherapy or pemetrexed treatment option. However, as discovered by our investigation, TTF-1 cannot forecast a portion of the lung adenocarcinomas that had a selective sensitivity to pemetrexed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tlcr.2019.12.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082290PMC
February 2020

Feasibility, uptake and impact of a hospital-wide tobacco addiction treatment pathway: Results from the CURE project pilot.

Clin Med (Lond) 2020 03;20(2):196-202

Greater Manchester Health and Social Care Partnership, Manchester, UK.

Introduction: Providing comprehensive tobacco addiction treatment to smokers admitted to acute care settings represents an opportunity to realise major health resource savings and population health improvements.

Methods: The CURE project is a hospital-wide tobacco addiction treatment service piloted in Wythenshawe Hospital, Manchester, UK. The core components of the project are electronic screening of all patients to identify smokers; the provision of brief advice and pharmacotherapy by frontline staff; opt-out referral of smokers to a specialist team for inpatient behavioural interventions; and continued support after discharge.

Results: From 01 October 2018 to 31 March 2019, 92% (13,515/14,690) of adult admissions were screened for smoking status, identifying 2,393 current smokers. Of these, 96% were given brief advice to quit by the admitting team. Through the automated 'opt-out' referral process, 61% patients completed inpatient behavioural interventions with a specialist cessation practitioner (69% within the first 48 hours of admission). Overall, 66% of smokers were prescribed pharmacotherapy. Over one in five of all smokers admitted during this pilot reported that they were abstinent from smoking 12 weeks after discharge (22%) at a cost £183 per quit.

Discussion: National implementation of this cost-effective programme would be likely to generate substantial benefits to public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/clinmed.2019-0336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081814PMC
March 2020

Great debate: surgery versus stereotactic radiotherapy for early-stage non-small cell lung cancer.

Thorax 2020 03 21;75(3):198-199. Epub 2020 Jan 21.

North West Lung Centre, University Hospital South Manchester, Manchester, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2019-214014DOI Listing
March 2020

Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial.

JAMA 2019 Dec 5. Epub 2019 Dec 5.

Academic Respiratory Unit, University of Bristol, Bristol, United Kingdom.

Importance: Malignant pleural effusion (MPE) is challenging to manage. Talc pleurodesis is a common and effective treatment. There are no reliable data, however, regarding the optimal method for talc delivery, leading to differences in practice and recommendations.

Objective: To test the hypothesis that administration of talc poudrage during thoracoscopy with local anesthesia is more effective than talc slurry delivered via chest tube in successfully inducing pleurodesis.

Design, Setting, And Participants: Open-label, randomized clinical trial conducted at 17 UK hospitals. A total of 330 participants were enrolled from August 2012 to April 2018 and followed up until October 2018. Patients were eligible if they were older than 18 years, had a confirmed diagnosis of MPE, and could undergo thoracoscopy with local anesthesia. Patients were excluded if they required a thoracoscopy for diagnostic purposes or had evidence of nonexpandable lung.

Interventions: Patients randomized to the talc poudrage group (n = 166) received 4 g of talc poudrage during thoracoscopy while under moderate sedation, while patients randomized to the control group (n = 164) underwent bedside chest tube insertion with local anesthesia followed by administration of 4 g of sterile talc slurry.

Main Outcomes And Measures: The primary outcome was pleurodesis failure up to 90 days after randomization. Secondary outcomes included pleurodesis failure at 30 and 180 days; time to pleurodesis failure; number of nights spent in the hospital over 90 days; patient-reported thoracic pain and dyspnea at 7, 30, 90, and 180 days; health-related quality of life at 30, 90, and 180 days; all-cause mortality; and percentage of opacification on chest radiograph at drain removal and at 30, 90, and 180 days.

Results: Among 330 patients who were randomized (mean age, 68 years; 181 [55%] women), 320 (97%) were included in the primary outcome analysis. At 90 days, the pleurodesis failure rate was 36 of 161 patients (22%) in the talc poudrage group and 38 of 159 (24%) in the talc slurry group (adjusted odds ratio, 0.91 [95% CI, 0.54-1.55]; P = .74; difference, -1.8% [95% CI, -10.7% to 7.2%]). No statistically significant differences were noted in any of the 24 prespecified secondary outcomes.

Conclusions And Relevance: Among patients with malignant pleural effusion, thoracoscopic talc poudrage, compared with talc slurry delivered via chest tube, resulted in no significant difference in the rate of pleurodesis failure at 90 days. However, the study may have been underpowered to detect small but potentially important differences.

Trial Registration: ISRCTN Identifier: ISRCTN47845793.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.2019.19997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990658PMC
December 2019

Attending community-based lung cancer screening influences smoking behaviour in deprived populations.

Lung Cancer 2020 01 1;139:41-46. Epub 2019 Nov 1.

Manchester Thoracic Oncology Centre, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

Objectives: The impact of lung cancer screening on smoking is unclear, especially in deprived populations who are underrepresented in screening trials. The aim of this observational cohort study was to investigate whether a community-based lung cancer screening programme influenced smoking behaviour and smoking attitude in socio-economically deprived populations.

Material And Methods: Ever-smokers, age 55-74, registered at participating General Practices were invited to a community-based Lung Health Check (LHC). This included an assessment of respiratory symptoms, lung cancer risk (PLCO), spirometry and signposting to stop smoking services. Those at high risk (PLCO≥1.51%) were offered annual low-dose CT screening over two rounds. Self-reported smoking status and behaviour were recorded at the LHC and again 12 months later, when attitudes to smoking were also assessed.

Results: 919 participants (51% women) were included in the analysis (77% of attendees); median deprivation rank in the lowest decile for England. At baseline 50.3% were current smokers. One-year quit rate was 10.2%, quitting was associated with increased baseline symptoms (OR 2.62, 95% CI 1.07-6.41; p = 0.035) but not demographics or screening results. 55% attributed quitting to the LHC. In current smokers, 44% reported the LHC had made them consider stopping, 29% it made them try to stop and 25% made them smoke less whilst only 1.7% and 0.7% said it made them worry less about smoking or think it acceptable to smoke.

Conclusions: Our data suggest a community-based lung cancer screening programme in deprived areas positively impacts smoking behaviour, with no evidence of a 'licence to smoke' in those screened.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lungcan.2019.10.025DOI Listing
January 2020

Training opportunities in thoracic ultrasound for respiratory trainees: are current guidelines practical?

BMJ Open Respir Res 2019 3;6(1):e000390. Epub 2019 Oct 3.

Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.

Introduction: Respiratory trainees in the UK face challenges in meeting current Royal College of Radiologists (RCR) Level 1 training requirements for thoracic ultrasound (TUS) competence, specified as attending 'at least one session per week over a period of no less than 3 months, with approximately five scans per session performed by the trainee (under supervision of an experienced practitioner)'. We aimed to clarify where TUS training opportunities currently exist for respiratory registrars.

Methods: Data were collected (over a 4-week period) to clarify the number of scans (and therefore volume of training opportunities) within radiology departments and respiratory services in hospitals in the South West, North West deaneries and Oxford.

Results: 14 hospitals (including three tertiary pleural centres) provided data. Of 964 scans, 793 (82.3%) were conducted by respiratory teams who performed a mean of 17.7 scans per week, versus 3.1 TUS/week in radiology departments. There was no radiology session in any hospital with ≥5 TUS performed, whereas 8/14 (86%) of respiratory departments conducted such sessions. Almost half (6/14) of radiology departments conducted no TUS scans in the period surveyed.

Conclusions: The currently recommended exposure of regularly attending a list or session to undertake five TUS is not achievable in radiology departments. The greatest volume of training opportunities exists within respiratory departments in a variety of scheduled and unscheduled settings. Revision of the competency framework in TUS, and where this is delivered, is required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjresp-2018-000390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797304PMC
April 2020

Development and Maintenance of a Pleural Disease Service: Role of the "Pleurologist".

Semin Respir Crit Care Med 2019 06 16;40(3):297-304. Epub 2019 Sep 16.

Department of Surgery, Interventional Pulmonary, Yale New Haven Hospital, CT, USA.

Changes in the health care environment, increasing specialization, and the use of ultrasound have led to pleural diseases being managed by a select few. This article aims to look at the impact of current medical education paradigms, service structure, procedural education and role of the "pleurologist" in providing care to patients with pleural disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1693405DOI Listing
June 2019

Attendees of Manchester's Lung Health Check pilot express a preference for community-based lung cancer screening.

Thorax 2019 12 3;74(12):1176-1178. Epub 2019 Sep 3.

Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK.

Manchester's 'Lung Health Check' pilot utilised mobile CT scanners in convenient retail locations to deliver lung cancer screening to socioeconomically disadvantaged communities. We assessed whether screening location was an important factor for those attending the service. Location was important for 74.7% (n=701/938) and 23% (n=216/938) reported being less likely to attend an equivalent hospital-based programme. This preference was most common in current smokers (27% current smokers vs 19% former smokers; OR 1.46, 95% CI 1.03 to 2.08, p=0.036) and those in the lowest deprivation quartile (25% lowest quartile vs 17.6% highest quartile; OR 2.0, 95% CI 1.24 to 3.24, p=0.005). Practical issues related to travel were most important in those less willing to attend a hospital-based service, with 83.3% citing at least one travel related barrier to non-attendance. A convenient community-based screening programme may reduce inequalities in screening adherence especially in those at high risk of lung cancer in deprived areas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2018-212601DOI Listing
December 2019

CT screening for lung cancer: Are we ready to implement in Europe?

Lung Cancer 2019 08 28;134:25-33. Epub 2019 May 28.

Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK.

Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lungcan.2019.05.028DOI Listing
August 2019

Baseline predictors of negative and incomplete pleural cytology in patients with suspected pleural malignancy - Data supporting 'Direct to LAT' in selected groups.

Lung Cancer 2019 07 16;133:123-129. Epub 2019 May 16.

Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK. Electronic address:

Objectives: Negative effusion cytology is more common in certain forms of Malignant Pleural Effusion (MPE) and results in pathway delay. Local Anaesthetic Thoracoscopy (LAT) is extremely sensitive and safe but cannot be offered to all. A stratified pathway, including 'Direct to LAT' in selected cases could enhance patient experience but requires reliable baseline predictors of unhelpful cytology, including both negative (no malignant cells) and incomplete results (malignant cells identified but predictive markers failed), since pleural biopsies will be required in the latter for optimal management. This retrospective analysis of a prospective multi-centre study, sought to identify baseline features for pathway rationalization.

Materials And Methods: 363/638 (57%) of patients recruited to the DIAPHRAGM study (ISRCTN10079972) were included. Prospective data, including final diagnoses, asbestos exposure and fluid cytology results were supplemented by retrospective Computed Tomography (CT) and predictive marker reports. Independent predictors of negative and incomplete cytology were determined by multivariable logistic regression. Contingency tables were used to assess diagnostic value of cytology in associated phenotypes.

Results: 238/363 (66%) patients were diagnosed with MPE (18 tumour types). Fluid cytology was negative in 151/238 (63%) and independently associated with asbestos-exposure (Odds Ratio (OR) 5.34) and a malignant CT (OR 2.25). When both features were recorded the sensitivity and negative predictive value of fluid cytology were 19% (95% CI 11-30%) and 9% (95% CI 4-20%)), respectively. Cytology was incomplete in 34/238 (14%), i.e. 47% of positive cytology cases) but was not associated with any baseline feature. ORs for incomplete cytology in Ovarian, Breast, Renal and Lung Cancer were 83, 22, 21 and 9, respectively.

Conclusion: Negative cytology is extremely likely in patients with asbestos exposure and a malignant CT report. A 'Direct-to-LAT' approach may be appropriate in this setting. No baseline predictors of incomplete cytology were identified.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lungcan.2019.05.017DOI Listing
July 2019

Predicting survival following surgical resection of lung cancer using clinical and pathological variables: The development and validation of the LNC-PATH score.

Lung Cancer 2018 11 31;125:29-34. Epub 2018 Aug 31.

Manchester Thoracic Oncology Centre, North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK; Institute of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford Road, Manchester, UK.

Introduction: The aim of this study was to develop and validate a simple prognostic scoring system using readily available clinical and pathological variables that could stratify patients according to the risk of death following lung cancer resection. We hypothesized that by using additional pathological variables not accounted for by pathological stage alone coupled with markers of overall fitness a new prognostic tool could be developed.

Methods: Multivariable logistic regression analysis of pathological and other clinical variables from patients undergoing surgical resection of non-small cell lung cancer (NSCLC) were used to determine factors independently associated with 2-year overall survival and so derive the scoring system. The model was then validated in an external multi-centre dataset.

Results: Using multivariable logistic regression on a large dataset (n = 1,421) the 'LNC-PATH' (Lymphovascular invasion, N-stage, adjuvant Chemotherapy, Performance status, Age, T-stage, Histology) prognostic score was devised and then validated using an external dataset (n = 402). This can be used to risk stratify patients into low, moderate and high-risk groups with a statistically significant difference between the three groups in their survival distributions. 83.8% of patients in the low-risk group survived two years after surgery compared to 55.6% in the moderate-risk group and 26.2% in the high-risk group. The score was shown to perform moderately well with an Area Under the Receiver Operating Characteristic curve (AUROC) value of 0.76 (95% CI: 0.73-0.79) and 0.70 (95% CI: 0.64-0.76) in the derivation and validation cohorts respectively.

Discussion: The LNC-PATH score predicts 2-year overall survival after surgery for NSCLC. This may allow the development of risk stratified follow-up protocols in survivorship clinics which could be the subject of future prospective studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lungcan.2018.08.026DOI Listing
November 2018

Second round results from the Manchester 'Lung Health Check' community-based targeted lung cancer screening pilot.

Thorax 2019 07 12;74(7):700-704. Epub 2018 Nov 12.

Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

We report results from the second annual screening round (T1) of Manchester's 'Lung Health Check' pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/thoraxjnl-2018-212547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585285PMC
July 2019

New drugs in thoracic oncology: needs and knowledge - an online ERS Lung Cancer Assembly survey.

ERJ Open Res 2018 Jul 3;4(3). Epub 2018 Sep 3.

Chest Dept and Thoracic Oncology Expert Center, AP-HP Hôpital Tenon and Medicine Sorbonne University, Paris, France.

In the last decade, systemic therapy for advanced lung cancer has become diverse, complex and personalised. These new therapies (monoclonal antibodies, tyrosine kinase inhibitors (TKIs) and immunotherapy) have a far different toxicity profile compared to chemotherapy. Furthermore, clinical indications and reimbursement criteria can vary across Europe. The aim of the present online survey was to assess the knowledge, views and challenges facing the European respiratory community in this rapidly changing field. A 15-question web survey was sent to all European Respiratory Society members through the Society's monthly electronic communication. A total of 315 questionnaires were completed. Most of the respondents were male (59.1%), were above 40 years of age (52.9%) and were working in university/academic hospitals (74.8%), the majority as pulmonologists (90%). Only 55% of the participants were aware of the legal processes for drug recognition. Except for epidermal growth factor receptor TKI, up to 38% did not know about the specific toxicities of anaplastic lymphoma kinase/ROS proto-oncogene 1 TKIs, monoclonal antibodies and immune checkpoint inhibitors. Of the respondents, 92% showed an interest in an online platform reporting new drugs' toxicities. Despite a large amount of publicity and integration of new drugs into therapeutic algorithms and clinical guidelines, physicians taking care of lung cancer patients have a need for up-to-date information on systemic therapy toxicity management and legal constraints.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1183/23120541.00040-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119830PMC
July 2018

Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians.

BMJ Open Respir Res 2018 3;5(1):e000307. Epub 2018 Aug 3.

Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK.

Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital. Its content has been formed on the basis of literature review, national guidelines, National Health Service England policy and consensus opinion following a round table discussion. Recommendations have been provided in the broad themes of procedural training, out-of-hours management and pleural service specification. Procedural competences have been defined into descriptive categories: emergency, basic, intermediate and advanced. Provision of emergency level operators at all times in all trusts is the cornerstone of out-of-hours recommendations, alongside readily available escalation pathways. A proposal for minimum standards to ensure the safe delivery of pleural medicine have been described with the aim of driving local conversations and providing a framework for service development, review and risk assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjresp-2018-000307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089266PMC
August 2018

An Inconvenient Truth Concerning Surgery for Mesothelioma.

J Clin Oncol 2018 09 14;36(26):2745-2746. Epub 2018 Jun 14.

Duneesha de Fonseka, University of Bristol, North Bristol NHS Trust, Bristol, United Kingdom; Mark Slade, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; Kevin G. Blyth, Queen Elizabeth University Hospital and University of Glasgow, United Kingdom; John Edwards, Sheffield Teaching Hospitals, Sheffield, United Kingdom; Matthew Evison, Wythenshawe Hospital, Manchester, UK; Mark Roberts, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, United Kingdom; Najib Rahman, University of Oxford, Oxford, United Kingdom; Ian Woolhouse, University Hospitals of Birmingham, Birmingham, United Kingdom; and Nick A. Maskell, University of Bristol, North Bristol NHS Trust, Bristol, United Kingdom.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1200/JCO.2018.78.6590DOI Listing
September 2018

Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion.

N Engl J Med 2018 04;378(14):1313-1322

From the Academic Respiratory Unit, University of Bristol (R.B., S.P.W., A.C.B., N.A.M.), and North Bristol NHS Trust (R.B., E.K.K., A.J.M., S.P.W., A.C.B., S.S., L.J.S., N.J.Z.-E., J.E.H., N.A.M.), Bristol, the Pragmatic Clinical Trials Unit, Queen Mary University of London (B.C.K.), Guy's and St. Thomas' NHS Foundation Trust (L.A., A.W.), King's College School of Medicine, King's College University (L.A.), and the Institute for Global Health, University College London (R.F.M.), London, Great Western Hospitals NHS Foundation Trust, Swindon (A.E.S.), University Hospital of North Midlands NHS Trust, Stoke-on-Trent (M.H.), the School of Medicine, Keele University, Newcastle-under-Lyme (M.H.), North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees (R.N.H.), South Tees Hospitals NHS Foundation Trust, Middlesbrough (R.A.M.), Portsmouth Hospitals NHS Trust, Portsmouth (L.J.B.), Manchester University NHS Foundation Trust, Manchester (J. Holme, M.E.), Lancashire Teaching Hospitals NHS Foundation Trust, Preston (M.M.), Cambridge University Hospitals NHS Foundation Trust, Cambridge (P.S., J. Herre), Northumbria Healthcare NHS Foundation Trust, North Shields (D.C.), Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield (M.R.), NHS Ayrshire and Arran, Ayr (A.G.), Worcester Acute Hospitals NHS Trust, Worcester (C.H.), Royal United Hospitals Bath NHS Foundation Trust, Bath (J.W.), Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool (T.S.S.), Aintree University Hospitals NHS Foundation Trust, Liverpool (B.C.), Hampshire Hospitals NHS Foundation Trust, Winchester (S.G.), and the Oxford Respiratory Trials Unit, University of Oxford (I.P., N.M.R.), the Oxford University Hospitals NHS Foundation Trust (I.P., N.M.R.), and the Oxford NIHR Biomedical Research Centre (N.M.R.), Oxford - all in the United Kingdom; and the Institute for Respiratory Health, University of Western Australia, and Sir Charles Gairdner Hospital, Perth, WA, Australia (Y.C.G.L.).

Background: Malignant pleural effusion affects more than 750,000 persons each year across Europe and the United States. Pleurodesis with the administration of talc in hospitalized patients is the most common treatment, but indwelling pleural catheters placed for drainage offer an ambulatory alternative. We examined whether talc administered through an indwelling pleural catheter was more effective at inducing pleurodesis than the use of an indwelling pleural catheter alone.

Methods: Over a period of 4 years, we recruited patients with malignant pleural effusion at 18 centers in the United Kingdom. After the insertion of an indwelling pleural catheter, patients underwent drainage regularly on an outpatient basis. If there was no evidence of substantial lung entrapment (nonexpandable lung, in which lung expansion and pleural apposition are not possible because of visceral fibrosis or bronchial obstruction) at 10 days, patients were randomly assigned to receive either 4 g of talc slurry or placebo through the indwelling pleural catheter on an outpatient basis. Talc or placebo was administered on a single-blind basis. Follow-up lasted for 70 days. The primary outcome was successful pleurodesis at day 35 after randomization.

Results: The target of 154 patients undergoing randomization was reached after 584 patients were approached. At day 35, a total of 30 of 69 patients (43%) in the talc group had successful pleurodesis, as compared with 16 of 70 (23%) in the placebo group (hazard ratio, 2.20; 95% confidence interval, 1.23 to 3.92; P=0.008). No significant between-group differences in effusion size and complexity, number of inpatient days, mortality, or number of adverse events were identified. No significant excess of blockages of the indwelling pleural catheter was noted in the talc group.

Conclusions: Among patients without substantial lung entrapment, the outpatient administration of talc through an indwelling pleural catheter for the treatment of malignant pleural effusion resulted in a significantly higher chance of pleurodesis at 35 days than an indwelling catheter alone, with no deleterious effects. (Funded by Becton Dickinson; EudraCT number, 2012-000599-40 .).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMoa1716883DOI Listing
April 2018