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Recurrent malignant pleural effusion in advanced cancer — SCE Acute Medicine MCQ

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ModerateCancer, palliative care and haematologyRecurrent malignant pleural effusion in advanced cancerSCE Acute Medicine

A 68-year-old man with metastatic lung cancer is admitted with worsening dyspnoea. He is cachectic, bedbound and has chosen not to have further oncological treatment. Chest radiograph shows large recurrent right pleural effusion and widespread metastases. He is comfortable on low-flow oxygen but asks whether another drain will meaningfully change the situation. What would you advise this patient?

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Correct answer: B — Explore his goals and explain that symptom-focused care, including drainage only if it improves comfort, is appropriate

This is a communication and decision-making scenario in advanced disease, where treatment should be guided by goals, burdens and likely symptomatic benefit. Recurrent drainage can help selected patients, but it is not obligatory when the priority is comfort and prognosis is limited. Avoiding honest discussion or escalating invasive treatment without patient-centred rationale is poor acute medical practice.

Reference: NICE NG142; GMC Treatment and care towards the end of life