This is a multicentre randomised controlled trial evaluating global health related quality of life outcomes in patients with malignant pleural effusions. Patients will be randomised to receive either chest drain and talc pleurodesis or indwelling pleural catheter and talc pleurodesis. Patients will be followed up for 3 months post intervention

Inclusion Criteria:

1. Diagnosis of malignant pleural effusion
2. WHO performance status 2 or less unless performance status is impaired by presence of effusion and likely to significantly improve with drainage
3. Expected survival greater than 3 months

Exclusion Criteria:

1. Age less than 18 years old

2. Pregnant or lactating

3. Known allergy to Talc or Lignocaine

4. Lack of symptomatic relief from effusion drainage

5. At least twice weekly drainage cannot be undertaken

6. Lymphoma or small cell carcinoma except*:

   1. Failure of chemotherapy
   2. Deemed for palliative management

7. Non malignant effusions

8. Loculated pleural effusion

9. Unable to provide written informed consent to trial participation