A study is to assess the role of LENT among palliative care cancer patients and assessed the different patient, tumor, and treatment-related factors that may affect survival. Malignant pleural effusion (MPE) has varied survival and indicates advanced disease. LENT prognostic score is the first validated score used for MPE. 

Malignant pleural effusion (MPE) occurs in approximately 15% of cancer patients. MPE indicates advanced disease with a median survival of about 3–12 months. The Mortality rates are 37% and 77% at 30 days and one year, respectively. The management of MPE includes different therapeutic options: therapeutic pleural tap, intercostal tube drainage and pleurodesis, indwelling pleural catheter, best supportive care.

With the heterogeneity in the group of patients with MPE, there is a challenge to predict prognosis and survival. With improved techniques in the management of pleural effusion and better oncological options, there is an increasing need for good prognostication to tailor the most appropriate treatment. Many factors affect survival including the tumor type, performance, and systemic inflammatory markers.

MPE signifies advanced disease and is often associated with poor prognosis. The most common cancer in our group of patients with MPE was lung (41.7%), followed by breast (27.1%). This finding is similar to what is known that MPE occurs most commonly in the lung, followed by breast. Lung cancer is the most common cause of MPE in men and breast cancer in women. MPE occurs in about 8%–38% of patients with lung cancer.

Patients with lung cancer had the shortest ST, both in the LENT validation cohort (2.5 months) and in the present study (7 months). The better ST and survival rates in our study group as compared to the LENT validation study cohort could be because all patients in the LENT validation study cohort had symptomatic MPE and may have been seen later in the course of the illness. Presence of pleural effusion at initial presentation in lung cancer has been associated with shorter survival, in both non-small cell and small cell lung cancers.  

The limitations of our study include the small sample size and the retrospective design. LENT prognostic scoring was possible only in 31%. This group represents only those who were referred and followed up until death in palliative care outpatient clinic and did not represent the entire group of patients with MPE.

Implications 

There is a need for larger prospective studies to study the role of LENT prognostic score among palliative care patients in hospital, community, and hospice settings. The usefulness of LENT score should be translated to oncological decision-making, and risk-based treatment algorithm should be developed to aid the management of MPE.

Poor ECOG performance status, bilateral effusion, and no oncological treatment after diagnosis of MPE were factors associated with poor survival. Lung cancer was associated with shorter OS and ST. As highlighted, there is a need for larger multicenter prospective studies to study the role of LENT prognostic score among palliative care patients in different settings.