Multidisciplinary approach to managing recurrent pericardial effusion in cancer patients: insights from a 5-year single-center experience

Introduction Pericardial effusion in cancer patients is associated with worse prognosis. The standard treatment for large pericardial effusions that cause hemodynamic compromise is pericardiocentesis, which aims to relieve symptoms, facilitate the continuation of cancer therapy, and enhance the patient's quality of life. However, recurrence of pericardial effusion is common. One of the most consistent prognostic factors for poor outcomes in these patients is the detection of cancer cells in the pericardial fluid. Purpose This study seeks to analyze the clinical characteristics of cancer-associated pericardial effusion in patients who underwent pericardiocentesis at the Intensive Cardiac Care Unit of a university hospital over the past five years. Methods We conducted a retrospective review of the medical records for all patients who underwent pericardiocentesis between 2019 and 2024. The analysis focused on patient demographics, cancer type, effusion size, and the presence of cancer cells in the pericardial fluid. Additionally, we assessed recurrence of effusion, the need for repeat pericardiocentesis, the time to recurrence, and the impact on the continuation of cancer treatment. Results A total of 60 patients were included in the study, 46% of whom had cancer-related pericardial effusion. The median age of these patients was 71 years (range: 42-87). The most common cancers were lung (n=13) and breast cancer (n=5). Cancer cells were detected in the pericardial effusion of 19 patients (67%), with a median effusion size of 27.5 mm (range: 10-50 mm). Following initial pericardiocentesis, 10 patients received specific anticancer therapy: 6 patients had newly diagnosed cancers and began treatment, while 4 continued their existing cancer treatments. Seven patients, due to poor clinical status, were not candidates for anticancer therapy, and data for 6 others were unavailable. Among the surviving patients, 43% experienced recurrent pericardial effusion, with 30% requiring repeat pericardiocentesis. The median time to recurrence was 30 days (range: 13-34 days), although the sample size for this analysis was small. Conclusion Recurrent pericardial effusion is common in cancer patients, highlighting the importance of a multidisciplinary approach involving both cardiologists and oncologists. Timely management is essential to effectively address pericardial effusion, ensure the continuation of cancer treatment, and ultimately improve the patient's quality of life.