The TIME1 trial has found that the type of painkiller used makes no difference when treating a complication of lung cancer. The study compared NSAIDs (nonsteroidal anti-inflammatory drugs) with opiates.
The results were published in JAMA on 22 December. The study looked at which type of painkiller would work best during treatment for malignant pleural effusion. It also examined if different chest tube sizes affected the level of pain. The evidence for the best method of treatment was previously poor.
Malignant pleural effusion is a side effect of lung cancer. It happens when cancer spreads to membranes outside the lungs, where fluid then collects. This can be treated by 'pleurodesis'. This is where the fluid is drained and the cavity left sealed using talc, so it cannot return. This is often very painful.
The study recruited 320 patients, from 14 centres all over the UK, and two in North America. Researchers divided patients into those having thoracoscopy (examination, therapy or surgery of the chest using a camera), and those not. Patients having thoracoscopy were randomly given either NSAIDs or opiates, and a larger chest tube.
Patients not having thoracoscopy were randomly put into four groups:
- A larger chest tube and opiates
- A larger chest tube and NSAIDs
- A smaller chest tube and opiates
- A smaller chest tube and NSAIDs
Results showed that the type of painkiller had no effect on pain levels during the procedure. However, those using NSAIDs needed a small amount of extra pain medicine whilst the chest tube was in place. NSAID use also did not reduce the success of the pleurodesis three months on.
Smaller tubes lessened pain slightly for those patients who did not have thoracoscopy, but they were associated with more complications during insertion. They also resulted in higher fall out rates and a higher rate of not being able to administer talc.
The data suggested larger tubes were more effective for pleurodesis by an estimated margin of 10%. They were associated with fewer complications during insertion, less failure to give talc, and a lower proportion of falling out.
Malignant pleural effusion affects more than 300,000 patients per year, in the UK and USA combined. The study's authors believe the results challenge current guidelines. These suggest avoiding NSAIDs and using smaller chest tubes.