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Enhancing quality of life for cancer patients

Toronto, July 5, 2016

By Melissa Di Costanzo

Dr. Kieran McIntyre, Lee Monette and Jennifer Carvalho - the EASE team - look at an ultrasound
Administrative assistant Jennifer Carvalho, respirology RN Lee Monette and respirologist Dr. Kieran McIntyre comprise the EASE team and are pictured with an ultrasound provided by foundation donors. The ultrasound helps with the insertion of a catheter that helps remove fluid collection in cancer patients. (Photo by Katie Cooper)

Patients with cancer experiencing a build-up of fluid around their lungs (also called a malignant pleural effusion) will be able to breathe easier, thanks to an initiative that improves quality of life and either keeps them out of the hospital or ensures they are discharged earlier.

The Early Assessment of Symptomatic Effusion (EASE) program allows patients to have a catheter (or in some cases, catheters) inserted between the lung and chest wall. The catheter helps to remove fluid that collects in this area (also known as pleural effusion) due to cancer cells that block drainage. This blockage causes patients to become short of breath, often leading to a hospital admission that can last as many as 15 days.

The insertion of a catheter is an outpatient procedure that takes less than 20 minutes. Dr. Kieran McIntyre, a respirologist, follows up with patients and nurses make regular home visits to drain the fluid. In some cases, the catheter can be removed, as the fluid does not return.

“It’s a much less invasive process than pleurodesis, which may require surgery and may not work in all cases,” he said. “Some patients are not even candidates to undergo this procedure, and are left without options.”

Recovery from pleurodesis means patients require up to a three- to five-day hospital stay, which is not ideal for many patients.

Now, instead of staying at St. Michael’s, patients with this kind of cancer and shortness of breath are flagged as soon as they come to the Emergency Department or are seen in outpatient clinics with symptoms including shortness of breath. The EASE program team is called and offers patients the option of receiving pleurodesis or a catheter, often on an outpatient basis.

“Catheters enable patients to experience better quality of life at the end of their lives,” said Dr. McIntyre. “Some even go so far as to book trips with their families to experience lasting memories with loved ones for one last time.”

The program, which started here in 2011, was initiated by a team from Respirology with support from Complex Care. It also involves members from Hematology/Oncology, and Thoracic Surgery. A total of 85 patients have been followed, and the program is being expanded to allow patients with malignant ascites, or fluid in the abdomen, to also benefit from long-term drainage and relief of symptoms.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.