TY - JOUR
AR - JSO-2023-1-101
TI - Disparities in Access and Use of PleurX Catheters for Treatment of Malignant Pleural Effusion: A Literature and Experience Based Review
AU - Jay, Phansalkar
AU - Jacquelyn, Roth
AU - Huzaifa, Shakir
JO - Journal of Surgical Oncology
PY - 2023
DA - Fri 28, Jul 2023
SN - 2674-3000
DO - http://dx.doi.org/10.31487/j.JSO.2023.01.01
UR - https://www.sciencerepository.org/disparities-in-access-and-use-of_JSO-2023-1-101 
KW - PleurX catheter, malignant pleural effusion, access to care
AB - It is not uncommon for patients with metastatic cancer to experience recurrent buildup of fluid in their pleural space. These malignant pleural effusions (MPE) are often experienced in late-stage illness with limited (<1 year) life expectancy and often present with shortness of breath, chest pain and discomfort, contributing to the morbidity of the patient’s illness. Tunneled indwelling pleural catheters (IPCs), including the PleurX by Beckton Dickinson (Franklin Lakes, NJ), are devices that are inserted on an outpatient basis that allow rapid and self-administered relief of symptomatic dyspnea, thereby offering an important palliative care option to patients with MPE. Current literature suggests these IPCs have enhanced efficacy compared with existing treatment options for MPE such as recurrent thoracentesis. However, the maintenance of these IPCs, including dressing changes and monitoring of fluid levels to avoid overuse or contamination, ideally requires the assistance from a family member or a home health aide. In this paper, we postulate whether the cost and maintenance demand of IPCs make them inaccessible to underserved communities, thereby contributing to the existing health disparities in health outcome by socioeconomic class. While there exists, no current literature looking at this issue specifically, existing literature does support a significantly lower utilization of health home aids in black, hispanic, and low-income populations. Our own experience at a level 1 trauma center in Newark, NJ, serving an at risk, underserved community, further suggests that the required visiting nurse and bottle replacement time and resource costs are prohibitive for this population. Given our experience and the limited literature, we believe additional research is warranted to establish plausibility of IPC use in lower socioeconomic strata.