Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Future Healthcare Journal

  • FHJ Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About FHJ
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Future Healthcare Journal

futurehosp Logo
  • FHJ Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About FHJ
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Consolidating malignant pleural and peritoneal services during the COVID-19 response

Avinash Aujayeb
Download PDF
DOI: https://doi.org/10.7861/fhj.2020-0016
Future Healthc J June 2020
Avinash Aujayeb
ANorthumbria Specialist Emergency Care Hospital, Cramlington, UK
Roles: consultant in respiratory and acute medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: avinash.aujayeb@nhct.nhs.uk
  • Article
  • Info & Metrics
Loading

ABSTRACT

Delivery of routine and established medical care has been significantly disrupted by the COVID-19 pandemic. Acutely unwell patients are being prioritised, and large numbers of doctors and inpatient beds are required to deliver this care.

We have recognised the impact that this disruption will have on patients with presumed and/or confirmed pleural and/or peritoneal malignancies. We present our service transformation and hope that the learning from this reconfiguration can be adopted by other organisations.

KEYWORDS:
  • COVID-19
  • pleural
  • peritoneal
  • malignancy
  • SARS-CoV-2

Introduction

The COVID-19 pandemic poses significant and unprecedented challenges for reorganisation of care, redistribution of resources and constraints to service delivery.1,2 Guidance that has previously been developed over many months is currently being updated on almost a daily basis.3 Importantly, cancer services are being markedly impacted,4,5 leading to significant anxiety for patients and their carers.

Summary of previous service provision

Northumbria Healthcare NHS Foundation Trust has a catchment population of just under 600,000. Care is organised across four main hospitals: a ‘flagship’ acute care centre, and three ‘base sites’. The Trust runs a well-established and successful pleural effusion service6 comprising 10 pleural clinics a month and a fortnightly theatre list for procedures such as local anaesthetic medical thoracoscopy, indwelling pleural catheter placement and pleural biopsy. This service is provided by three respiratory consultants with a pleural interest, one at each of the three base sites, and a pleural research fellow. One of the respiratory consultants also works in acute medicine and provides an ‘in-reach’ service into the acute trust, and provision of effective ambulatory care services for pneumothoraces.7

In addition, the service has developed a pathway for the management of recurrent large volume malignant ascites using indwelling peritoneal catheters (IPCs) to reduce the high level of morbidity related to large volume paracenteses.8 IPC insertion is recommended by NICE, has a low complication rate and provides an estimated cost saving of £1051 per patient.9

Changes to service provision

All pleural clinics have been cancelled and any patients that may need intervention are seen in the lung cancer clinic, which is still being run on a reduced schedule. At the time of writing, there are two new patients with probable malignancy who will be seen next week by a member of the pleural team.

All theatre lists have been cancelled. Five patients booked for local anaesthetic medical thoracoscopy for cytology-negative exudative pleural effusions (on two different occasions) have been informed that biopsy is not currently possible, and that chemotherapy is not likely to be given even if a cancer was diagnosed. Treatment escalation plans for those patients have been difficult to put into place due to the underlying diagnostic uncertainty. Their symptoms due to fluid accumulation are being treated with IPCs; three patients have now had drains inserted. Placement has occurred in ‘clean’ rooms in the various sites by the pleural team. Governance policies relating to pre-procedure antibiotics and strict aseptic techniques are being adhered to, although some of the rooms do not have dedicated scrub sinks.

All patients with malignant ascites will be offered an IPC at first presentation; while not evidence-based, this is a pragmatic solution to reduce the need for recurrent attendance. The team will also carry out point-of-care abdominal ultrasound for ascites to obviate the need for input from radiology, especially as the vast majority of patients do not present acutely but instead are referred from oncology or palliative care services.

While ambulatory pneumothorax services have not so far been affected, the use of pleural vents offers a potential opportunity to avoid hospital admission in these patients.

We have had support from our drain supplier (Rocket Medical plc), enabling delivery of equipment to our sites, and have facilitated discussion with and advice for local district nurse teams who will support patients at home. As these patients are in the COVID-19 high risk group, drainage is only being performed as required for control of symptoms, with appropriate personal protective equipment.

Conclusions

Consolidating services for patients with pleural and peritoneal fluid has been a collaborative effort involving hospital and community healthcare providers, equipment suppliers, patients and their carers. In the medium to long term, patients in whom an IPC has been placed will require review to assess performance status and reconsider the need for biopsy and appropriate cancer treatment. Data on morbidity and mortality will need to be collected, to examine the direct impact of COVID-19 infection and the indirect consequences of the service changes described here.

Acknowledgements

Thanks to Dr Jo Szram for editing the manuscript to facilitate rapid publication.

  • © Royal College of Physicians 2020. All rights reserved.

References

  1. ↵
    1. Extance A
    . Covid-19 and long term conditions: what if you have cancer, diabetes, or chronic kidney disease? Br Med J 2020;368:m1174.
    OpenUrlFREE Full Text
  2. ↵
    1. Willan J
    , King AJ, Jeffery K, Bienz N. Challenges for NHS hospitals during covid-19 epidemic. Br Med J 2020;368:m1117.
    OpenUrlFREE Full Text
  3. ↵
    Centre for Evidence-Based Medicine. Oxford Covid-19 Evidence Service. cebm.net/oxford-covid-19/ [Accessed 26 March 2020].
  4. ↵
    1. Gossage L
    . Coronavirus means difficult, life-changing decisions for me and my cancer patients. The Guardian, 19 March 2020. www.theguardian.com/society/2020/mar/19/cancer-patients-coronavirus-outbreak-difficult-decisions [Accessed 26 March 2020].
  5. ↵
    NHS England. Clinical guide for the management of non-coronavirus patients requiring acute treatment: cancer. www.england.nhs.uk/coronavirus/publication/specialty-guides/ [Accessed 2 April 2020].
  6. ↵
    1. Aujayeb A
    , Parker S, Bourke S, et al. A review of a pleural service. J R Coll Physicians Edinb 2016;46:26–31.
    OpenUrl
  7. ↵
    1. Jones L
    , Johnston R, Aujayeb A. Ambulatory management of pneumothorax using a novel device: Rocket Pleural Vent. BMJ Case Rep 2019;12:e229408.
    OpenUrl
  8. ↵
    1. Armstrong L
    , Dewhurst F, Frew K, et al. Indwelling peritoneal catheter insertion for malignant ascites: service evaluation and guideline production. BMJ Support Palliat Care 2019;9:A46.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    National Institute for Health and Care Excellence. PleurX peritoneal catheter drainage system for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites. Medical technologies guidance [MTG9]. www.nice.org.uk/guidance/mtg9 [Accessed 26 March 2020].
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Consolidating malignant pleural and peritoneal services during the COVID-19 response
Avinash Aujayeb
Future Healthc J Jun 2020, 7 (2) 161-162; DOI: 10.7861/fhj.2020-0016

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Consolidating malignant pleural and peritoneal services during the COVID-19 response
Avinash Aujayeb
Future Healthc J Jun 2020, 7 (2) 161-162; DOI: 10.7861/fhj.2020-0016
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • ABSTRACT
    • Introduction
    • Summary of previous service provision
    • Changes to service provision
    • Conclusions
    • Acknowledgements
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Understanding the diagnosis and management of multisystem inflammatory syndrome in adults (MIS-A) in the UK: results of a national Delphi process
  • The clinical course of pneumomediastinum in patients with SARS-CoV-2 before invasive mechanical ventilation
  • COVID-19 infection causing residual gastrointestinal symptoms – a single UK centre case series
Show more COVID-19 rapid report

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home

Other Services

  • Advertising
futurehosp Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians