Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study

• Published in: Palliative medicine Vol. 36; no. 9; pp. 1408 - 1417
• Main Authors: Seah, Davinia SE, Wilcock, Andrew, Chang, Sungwon, Sousa, Mariana S, Sinnarajah, Aynharan, Teoh, Cy Oun, Allan, Simon, Chye, Richard, Doogue, Matthew, Hunt, Jane, Agar, Meera, Currow, David C
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-10-2022; Sage Publications Ltd
• Subjects: Abdominal pain; Ascites; Cancer; Catheterization; Clinical assessment; Cohort analysis; Frail; Medical procedures; Nausea; Palliative care; Australia; drainage; paracentesis; Ascites; neoplasms; palliative care
• ISSN: 0269-2163; 1477-030X
• DOI: 10.1177/02692163221122326

Background:
Paracentesis is commonly undertaken in patients with cancer-related ascites.
Aim:
To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting.
Design:
Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner.
Setting/participants:
Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50.
Results:
At T1 (n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak (n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation.
Conclusion:
Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.