Aims: 1. To identify the treatments used in the management of malignant ascites and describe opinions about their effectiveness 2. To systematically review trials assessing the efficacy of the main palliative treatment approaches; drainage, diuretic therapy and peritoneovenous shunts (Registered with the Cochrane Pain, Palliative Care and Supportive Care Group).
Method: The survey of practice was sent to 296 palliative care units and hospices. 239 (82%) responses were received reflecting the practice of 196 centres. The systematic review strategy was to search the main electronic databases (Medline, Embase, SIGLE, ZETOC, Cochrane database of controlled trials and systematic reviews, dissertation abstracts). The search strategy was broad using the free text terms ‘MALIGNANT AND ASCITES’ OR ‘PERITONEAL AND EFFUSION’. Mesh terms used in Medline were ‘NEOPLASMS AND ASCITES’.
Results: More physicians used diuretic therapy most of the time (62%) than drainage (44%). However some questioned the evidence base for their decisions and asked for recommendations. The systematic review identified only two randomised-controlled trials comparing drainage to an alternative treatment. There were no RCTs evaluating diuretic therapy or peritoneovenous shunts.
Conclusions: There is limited evidence upon which to base practice and it is not surprising there is confusion amongst physicians. The use of diuretic therapy is not supported by research, and it may be harmful. Drainage appears to cause least harm. Further research is required to inform practice decisions.