Timely Ultrasound-Guided Thoracentesis and Paracentesis for Refractory Dyspnea and Abdominal Distension in Terminally Ill Cancer Patients Receiving Home Hospice Care

Background Pleural effusion and ascites frequently cause refractory dyspnea and abdominal distension in patients with advanced cancer. Although ultrasound-guided thoracentesis and paracentesis are established procedures, accessing hospital- or outpatient-based drainage may impose substantial burdens on patients near the end of life. We evaluated the efficacy and safety of timely home-based ultrasound-guided thoracentesis and paracentesis for symptom relief in terminally ill patients with cancer receiving home hospice care. Methods We retrospectively analyzed prospectively collected clinical data from consecutive terminally ill patients with cancer who underwent ultrasound-guided thoracentesis or paracentesis in a home hospice setting between January 2020 and December 2025. Symptom severity was assessed using the Numerical Rating Scale (NRS). Respiratory rate, oxygen saturation (SpO 2 ), pulse rate, and systolic blood pressure were compared among routine stable home visits, immediately before drainage, and immediately after drainage. Results Twenty-seven thoracenteses were performed in 14 patients, and 55 paracenteses were performed in 33 patients. Symptom severity improved significantly after drainage in both groups. Respiratory rate and oxygen saturation returned toward values recorded during routine stable home visits, while pulse rate and systolic blood pressure approached patients’ usual physiological levels without clinically significant circulatory instability. Overall, 20 of 82 procedures (24.4%) were performed within 3 days of death, including 2 on the day of death. No serious clinically apparent procedure-related adverse events, including pneumothorax requiring intervention, re-expansion pulmonary edema, hemorrhage, infection, syncope, emergency hospitalization, or procedure-related death, were observed. Conclusions Timely home-based ultrasound-guided thoracentesis and paracentesis were associated with substantial symptom relief without serious clinically apparent procedure-related adverse events in terminally ill patients with cancer. These findings suggest that, in appropriately selected patients and when performed by an experienced clinician, symptom-directed drainage may remain a feasible palliative option even during the final days of life while allowing patients to remain in their home care environment.