The Effects of the Pleural Interventions on Patients' Performance Status, Dyspnea, and Pain Scores in Patients Receiving Palliative Care

Document Type : Original Article


1 Division of Palliative Care Unit, Chief physician, Kars Harakani State Hospital, Kars, Turkey.

2 Department of Thoracic Surgery, Kars Harakani State Hospital, Kars, Turkey.


Instruction : Palliative care units aim to improve the quality of life and alleviate symptoms in patients with serious illnesses. Dyspnea, a distressing symptom, can significantly impact patients' quality of life. While various methods are used to manage dyspnea in palliative patients, surgical interventions may be overlooked or underutilized due to patient-specific considerations. This study investigates the effects of pleural interventions on quality of life, dyspnea, and pain scores in palliative care patients.
Materials and Methods : This retrospective case series analyzed data from 213 patients treated in a palliative care service between May 2022 and May 2023. Patients who underwent pleural interventions for dyspnea control were included. Data on patient characteristics, pleural pathologies, type of intervention (thoracentesis, indwelling pleural catheter or tube thoracostomy), complications, modified Borg dyspnea scale, Karnofsky Performance Scale (KPS), and visual analog scale (VAS) scores were collected.
Results : A total of 21 patients met the inclusion criteria. Thoracentesis was the most commonly performed intervention. After pleural intervention, Borg dyspnea scale scores significantly decreased (5.9-3.2, p<0.001), while KPS scores significantly increased (32.4-40.9, p<0.001). No significant difference was observed in VAS scores (3.1-3.4, p:0.25). Complications were minimal, with a small number of patients experiencing iatrogenic pneumothorax or catheter infection.
Conclusions :This study highlights the importance of pleural interventions in managing dyspnea and improving symptom control-related performance in palliative care patients. Therapeutic thoracentesis, pleural catheter insertion, and chest tube placement have demonstrated effectiveness in alleviating dyspnea. Therefore, pleural interventions should not be avoided if indicated in palliative care patients accompanied by dyspnea. However, potential complications and limitations must be considered, and patient-specific factors should guide decision-making.


  1. Rome RB, Luminais HH, Bourgeois DA, Blais CM. The role of palliative care at the end of life. Ochsner Journal. 2011 Dec 21;11(4):348-52.
  2. Medicine P, Partnership LA, Hospice N, Organization PC, Hospice and Palliative Nurses Association. National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for quality palliative care, executive summary. Journal of palliative medicine. 2004 Oct;7(5):611-27.
  3. Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, et al. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC medicine. 2020 Dec;18(1):1-25.
  4. Bennett MI, Ziegler L, Allsop M, Daniel S, Hurlow A. What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city. BMJ open. 2016 Dec 1;6(12):e012576.
  5. Kamal AH, Maguire JM, Wheeler JL, Currow DC, Abernethy AP. Dyspnea review for the palliative care professional: assessment, burdens, and etiologies. Journal of palliative medicine. 2011 Oct 1;14(10):1167-72.
  6. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: clinical significance in postoperative patients. The Journal of the American Society of Anesthesiologists. 2001 Dec 1;95(6):1356-61.
  7. Johnson MJ, Close L, Gillon SC, Molassiotis A, Lee PH, Farquhar MC. Use of the modified Borg scale and numerical rating scale to measure chronic breathlessness: a pooled data analysis. European Respiratory Journal. 2016 Jun 1;47(6):1861-4.
  8. Vere D. Oxford Textbook of Palliative Medicine. British Medical Journal. 1993 Nov 20;307(6915):1367-8.
  9. Havelock T, Teoh R, Laws D, Gleeson F. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010 Aug 1;65(Suppl 2):i61-76.
  10. Argento AC, Murphy TE, Pisani MA, Araujo KL, Puchalski J. Patient-centered outcomes following thoracentesis. Pleura. 2015 Sep 1;2:2373997515600404.
  11. Mallow C, Hayes M, Semaan R, Smith T, Hales R, Brower R, et al. Minimally invasive palliative interventions in advanced lung cancer. Expert review of respiratory medicine. 2018 Jul 3;12(7):605-14.
  12. Chalhoub M, Saqib A, Castellano M. Indwelling pleural catheters: complications and management strategies. Journal of thoracic disease. 2018 Jul;10(7):4659.
  13. Davies HE, Mishra EK, Kahan BC, Wrightson JM, Stanton AE, Guhan A, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: the TIME2 randomized controlled trial. Jama. 2012 Jun 13;307(22):2383-9.
  14. Porcel JM. Chest tube drainage of the pleural space: a concise review for pulmonologists. Tuberculosis and respiratory diseases. 2018 Apr 1;81(2):106-15.
  15. Cantey EP, Walter JM, Corbridge T, Barsuk JH. Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Current opinion in pulmonary medicine. 2016 Jul;22(4):378.
  16. Williams JG, Lerner AD. Managing complications of pleural procedures. Journal of Thoracic Disease. 2021 Aug;13(8):5242.