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Care of Malignant Bowel Obstruction in Patients With Advanced Gynecologic Cancer


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In a single-center retrospective study reported in the Journal of Oncology Practice, Lee et al found that implementation of an interprofessional malignant bowel obstruction program changed care patterns and improved outcomes for women with advanced gynecologic cancers and malignant bowel obstruction.

Study Details

The study was performed to evaluate the outcomes of women with advanced gynecologic cancer admitted to a large Canadian tertiary cancer center (Princess Margaret Cancer Centre) because of malignant bowel obstruction before (2014­­–2016, baseline group, n = 106) and after (2016­–2018, malignant bowel obstruction program group, n = 63) implementation of the malignant bowel obstruction program. Most women had ovarian cancer (73%) and small-bowel obstruction (78%).

The aim of the program was to integrate patients’ complex care needs across multiple disciplines and support women with malignant bowel obstruction. In brief, the program consisted of: expert consensus malignant bowel obstruction clinical care algorithms for inpatients and outpatients; patient education materials; standardized malignant bowel obstruction symptom triage and management tools; and guidance on advanced care planning and involvement of palliative care.

KEY POINTS

  • Average length of hospital stay was reduced in patients in the malignant bowel obstruction program.
  • The program was associated with increased overall survival.

Effects of Malignant Bowel Obstruction Program

Cumulative average length of hospital stay within the first 60 days of malignant bowel obstruction diagnosis was 13 days in the malignant bowel obstruction program group vs 22 days in the baseline group (adjusted P = .006; adjusted for age, histology, platinum sensitivity, and surgery). Median overall survival was 243 days vs 99 days (adjusted P = .002; adjusted for initial cancer stage and lines of chemotherapy).

Palliative care was received by 81% vs 82% of patients. Patients in the malignant bowel obstruction program group were more likely to receive palliative chemotherapy (83% vs 56%) and less likely to undergo palliative surgery (11% vs  21%). Use of total parenteral nutrition (27% vs 23%), stent procedures (8% vs 5%), and radiation therapy (5% vs 4%) were similar between groups; more patients in the malignant bowel obstruction group received two or more interventions (42% vs 33%).

The investigators concluded, “Implementation of a comprehensive, interprofessional malignant bowel obstruction program significantly affects patient care and may improve outcomes. Unique to this malignant bowel obstruction program is an integrated outpatient model of care and education that empowers patients to recognize malignant bowel obstruction symptoms for early intervention.”

Stephanie Lheureux, MD, PhD, of University Health Network, Toronto, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: The study was supported by funding from Princess Margaret Cancer Foundation. For full disclosures of the study authors, visit jop.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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