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Introduction Malignant pleural effusion (MPE) affects 50,000 patients per year in the UK and is characterized by debilitating symptoms of breathlessness. Talc pleurodesis (TP) and indwelling pleural catheters (IPC) are offered as definitive treatment options to manage MPE with no superiority of either treatment in symptom control. 1 However, IPCs are being increasingly offered as the preferred treatment due to perceived logistical challenges in delivering TP. The aim of this study is to understand the challenges of using TP as a treatment for MPE.Method We conducted a retrospective analysis of the pleural procedure dataset to identify all patients who were treated with talc pleurodesis (talc poudrage or slurry) for MPE between Jan’22 and Dec’24. Patient demographics, procedure wait times, admission duration, pleurodesis success and follow-up intervals were extracted from electronic medical records and analyzed.Results Of the 194 procedures performed to manage MPE, 40 patients were treated with TP. Median age was 77.5 ( IQR 18) ;22/40 (55%) were male. 35/40 (87.5%) were elective admissions with an average waiting time of 7.8 working days from time of decision to admission. Mean hospital stay was 8.8 days, reduced to 7.5 days for those who underwent thoracoscopy and talc poudrage. Daily drain output and chest X-ray were 1.4 times more likely to be used than the SIMPLE protocol to guide chest drain removal. Talc pleurodesis was successful in 61.3% of patients; 51.6% of patients had their first follow-up appointment at the recommended 2 weeks. 8/40 (20%) did not receive talc pleurodesis as planned due to reasons including dislodged chest drain, poorly expansile lung or pain intolerance.Conclusion Although TP is recommended as a first-line treatment for the management of MPE, timely delivery remains challenging with long waiting times. Local pleural services should work to provide TP as a treatment option to patients with an acceptable success rate in a timely fashion.Reference Roberts ME, Rahman NM, Maskell NA, et al. British thoracic society guideline for pleural disease: pleural malignancy. Thorax 2023;78(11):1143–1156. doi:10.1136/thorax-2023–220304