Management of the patient with a malignant pleural effusion.

A malignant pleural effusion (MPE) establishes an incurable stage of a malignancy. Median survival after detection of an MPE is 4 to 6 months in general populations of patients with cancer. Management of MPE centers on palliation of symptoms because no available treatments prolong survival. Mismanagement of MPE, however, can shorten survival and add to patients' burden of disease. Appropriate management requires a multidisciplinary approach with competency in existing treatment modalities to allow individualization of care. Although few prospective studies exist to guide clinical decisions, treating centers should present to patients the relative risks and benefits of different approaches and ensure that their institution's clinical outcomes in managing MPE match those of best clinical practices reported in the literature. Treatment of MPE is moving toward less interventional approaches that can manage patients in ambulatory settings thereby decreasing cost, discomfort, and time away from home for inpatient care.