Ken Masuda1, Hiroto Ishiki2, Naosuke Yokomichi3, Takuhiro Yamaguchi4, Tetsuya Ito5, Hana Takatsu6, Koji Amano7, Shuji Hiramoto8, Toshihiro Yamauchi9, Takashi Kawaguchi10, Masanori Mori11, Yosuke Matsuda12, Takashi Yamaguchi6. 1. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 2. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. ishiki-tky@umin.ac.jp. 3. Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan. 4. Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai-shi, Miyagi, 980-8574, Japan. 5. Department of Palliative Care, Japanese Red Cross Medical Center, 4-1-22 Hiro, Shibuya-ku, Tokyo, 150-8935, Japan. 6. Division of Palliative Care, Konan Medical Center, 1-5-16 Kamoshigawara, Higashinada-ku, Kobe-shi, Hyogo, 658-0064, Japan. 7. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 8. Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, 1 Katsuragosho-machi, Saikyo-ku, Kyoto, 658-0064, Japan. 9. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan. 10. Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan. 11. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, 3453 Mikatahara, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan. 12. Palliative Care Department, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Abstract
PURPOSE: Paracentesis is among the most widely utilized treatments for malignant ascites (MA). However, paracentesis in patients with MA has the potential to be associated with life-shortening effects. Thus, this study aimed to investigate whether paracentesis affected the duration of survival in such patients. METHODS: We performed a post hoc analysis of a prospective multicenter observational study investigating the dying process and end-of-life care in patients with terminal cancer, admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used inverse probability of treatment weighting (IPTW) to control for baseline covariates between groups. RESULTS: Among the 1896 initially enrolled patients, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The primary tumor site was the pancreas (51.9%, n = 295), followed by the gastrointestinal tract (22.7%, n = 129). Non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16-25) and 12 days (95% CI: 11-13) in the paracentesis and non-paracentesis groups, respectively (hazard ratio [HR]: 0.69, 95% CI: 0.54-0.88; p = 0.003). The IPTW-adjusted median survival durations were 22 (95% CI: 16-25) and 16 days (95% CI: 12-22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64-1.24; p = 0.492). No serious adverse events occurred in the paracentesis group. CONCLUSIONS: Paracentesis does not negatively affect the survival of patients with cancer and MA and can be a standard treatment in palliative care settings.
PURPOSE: Paracentesis is among the most widely utilized treatments for malignant ascites (MA). However, paracentesis in patients with MA has the potential to be associated with life-shortening effects. Thus, this study aimed to investigate whether paracentesis affected the duration of survival in such patients. METHODS: We performed a post hoc analysis of a prospective multicenter observational study investigating the dying process and end-of-life care in patients with terminal cancer, admitted to 23 palliative care units in Japan. Survival duration was compared between patients who did (paracentesis group) and did not undergo paracentesis (non-paracentesis group). We used inverse probability of treatment weighting (IPTW) to control for baseline covariates between groups. RESULTS: Among the 1896 initially enrolled patients, 568 with ascites were included in the study cohort. Eighty-five (15.0%) patients underwent paracentesis. The primary tumor site was the pancreas (51.9%, n = 295), followed by the gastrointestinal tract (22.7%, n = 129). Non-adjusted median durations of survival were 22 days (95% confidence interval [CI]: 16-25) and 12 days (95% CI: 11-13) in the paracentesis and non-paracentesis groups, respectively (hazard ratio [HR]: 0.69, 95% CI: 0.54-0.88; p = 0.003). The IPTW-adjusted median survival durations were 22 (95% CI: 16-25) and 16 days (95% CI: 12-22) in the paracentesis and non-paracentesis groups, respectively (HR: 0.89, 95% CI: 0.64-1.24; p = 0.492). No serious adverse events occurred in the paracentesis group. CONCLUSIONS: Paracentesis does not negatively affect the survival of patients with cancer and MA and can be a standard treatment in palliative care settings.