Illness Understanding, Prognostic Awareness and End of Life Care after Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Metastatic Gastrointestinal Cancer (FR481C)

PURPOSE: Malignant bowel obstruction (MBO) is common in advanced GI cancer, and MBO management, including drainage percutaneous endoscopic gastrostomy (dPEG), is palliative. How patients understand the goals of dPEG and its impact on disease is inadequately understood in the literature. Therefore, we analyzed these issues in patients with GI cancer. METHODS: Demographics, clinical variables, and patient outcomes were abstracted from the medical record. Illness understanding and future expectations were retrieved from palliative care notes. We described additional treatment and outcomes after dPEG and estimated overall survival (OS). RESULTS: From January 2015 to June 2017, 125 admitted patients with metastatic GI cancer underwent dPEG for MBO. Cancers were most commonly colorectal (34%) and pancreatic/ampullary (25%). During the dPEG admission, 32% (40 of 125) of patients had a palliative care consultation, and 22% (28 of 125) were asked about illness understanding and future expectations. All (28 of 28) reported good understanding of the advanced nature of their disease, but few were accurate about prognosis given their stage IV disease (10 of 28). Of the 117 (94%) discharged, 13% (15 of 117) received additional chemotherapy, which rarely prevented progression; half (63 of 117) had a do-not-resuscitate order; and most (101 of 117) were enrolled in hospice at death. Median time to death was 37 days (95% CI, 29 to 45 days); 6-month OS was 3.7% (95% CI, 1.2% to 8.4%). CONCLUSION: dPEGs are placed close to end of life in patients with advanced GI cancer. A minority of patients receive additional chemotherapy post-dPEG. Many have adequate disease understanding, but chemotherapy benefit is low, and future expectations vary. This may be an opportunity for improved communication regarding palliative procedures in advanced cancer.

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Therapy-related issues: palliative care

10.1093/med/9780198735823.003.0026 ◽

2017 ◽

Author(s):

Philip Wiffen ◽

Marc Mitchell ◽

Melanie Snelling ◽

Nicola Stoner

Keyword(s):

Spinal Cord ◽

Palliative Care ◽

End Of Life ◽

Bowel Obstruction ◽

End Of Life Care ◽

Cord Compression ◽

Life Care ◽

Malignant Bowel Obstruction ◽

Mouth Care ◽

Dying Patient

This chapter covers important information for the pharmacist relating to palliative care. Conditions commonly seen when caring for patients at the end of life are covered, including anorexia, fatigue, and anaemia. Other topics include hypercalcaemia of malignancy, mouth care, noisy breathing, insomnia, spinal cord compression, and malignant bowel obstruction. In addition, this chapter includes detail on the priorities for end-of-life care, relating these to prescribing in the dying patient.

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Percutaneous endoscopic gastrostomy for decompression of malignant bowel obstruction

Digestive Endoscopy ◽

10.1111/den.12139 ◽

2013 ◽

Vol 26 (2) ◽

pp. 208-213 ◽

Cited By ~ 22

Author(s):

Noboru Kawata ◽

Naomi Kakushima ◽

Masaki Tanaka ◽

Hiroaki Sawai ◽

Kenichiro Imai ◽

...

Keyword(s):

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Malignant Bowel Obstruction ◽

Endoscopic Gastrostomy

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Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Gastrointestinal Cancers: Prognosis and Implications for Timing of Palliative Intervention

Journal of Palliative Medicine ◽

10.1089/jpm.2016.0465 ◽

2017 ◽

Vol 20 (7) ◽

pp. 774-778 ◽

Cited By ~ 3

Author(s):

Kerry-Ann Pinard ◽

Tabitha N. Goring ◽

Barbara C. Egan ◽

Douglas J. Koo

Keyword(s):

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Malignant Bowel Obstruction ◽

Gastrointestinal Cancers ◽

Endoscopic Gastrostomy

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Who Goes Home after Palliation? Utilization of Venting Percutaneous Endoscopic Gastrostomy in Malignant Bowel Obstruction

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.06.391 ◽

2016 ◽

Vol 223 (4) ◽

pp. S49-S50

Author(s):

Christy E. Cauley ◽

Elizabeth J. Lilley ◽

Joel Weissman ◽

Angela M. Bader ◽

David L. Hepner ◽

...

Keyword(s):

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Malignant Bowel Obstruction ◽

Endoscopic Gastrostomy

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Palliative Care is Associated with Reduced Aggressive End-of-Life Care in Patients with Gastrointestinal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-018-6430-9 ◽

2018 ◽

Vol 25 (6) ◽

pp. 1478-1487 ◽

Cited By ~ 19

Author(s):

Shaila J. Merchant ◽

Susan B. Brogly ◽

Craig Goldie ◽

Christopher M. Booth ◽

Sulaiman Nanji ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Gastrointestinal Cancer ◽

End Of Life Care ◽

Life Care

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Malignant Bowel Obstruction

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909111406706 ◽

2011 ◽

Vol 28 (8) ◽

pp. 576-582 ◽

Cited By ~ 32

Author(s):

Elisabeth A. Dolan

Keyword(s):

Bowel Obstruction ◽

Percutaneous Endoscopic Gastrostomy ◽

Surgical Procedures ◽

Symptom Management ◽

Performance Status ◽

Malignant Bowel Obstruction ◽

Medical Interventions ◽

Less Invasive ◽

Endoscopic Gastrostomy ◽

Pelvic Malignancies

Malignant bowel obstruction is common in individuals with intra-abdominal and pelvic malignancies and results in considerable suffering. Treatments target both the resolution of obstruction and symptom management. Emerging procedures include stents placement in the bowel to return patency and newer surgical procedures that are evolving to be less invasive. The use of medical interventions like corticosteroids, alone or in concert with additional drugs, can be utilized to achieve resolution of obstruction. Throughout treatment, it is important to also aggressively treat obstructive symptoms like pain and nausea/vomiting. This can mostly be achieved with medications, but use of venting percutaneous endoscopic gastrostomy (PEG) can also relieve symptoms. Parenteral hydration and nutrition use remain controversial with this population. The factor most closely tied to prognosis is performance status.

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Overview and audit against Motor Neurone Disease (MND) Association guidelines of a MND consultant’s practice over the last 3 years at the [Hospital]

Res Medica ◽

10.2218/resmedica.v24i1.1563 ◽

2017 ◽

Vol 24 (1) ◽

pp. 65-74 ◽

Cited By ~ 1

Author(s):

Dominic Adam Worku ◽

Unnat Krishna ◽

Karen E Morrison

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Primary Care Physicians ◽

Diagnostic Delay ◽

Motor Neurone ◽

Motor Neurone Disease ◽

Life Care ◽

Endoscopic Gastrostomy ◽

Bulbar Onset ◽

Prompt Diagnosis

Background: Motor neurone disease (MND) is an incurable neurodegenerative condition. Recent guidelines from the MND Association UK (MNDA) emphasise prompt diagnosis and monitoring of quality of life (QOL). However, primary literature indicates that diagnosis is often delayed through several factors, including unawareness of how MND presents and delays through multiple secondary referrals. The [hospital] operates an internationally-recognised MND clinic whose service has not been audited against the MNDA UK guidelines for the last 3 years.Aim: To assess how well the MND consultant’s service ensures prompt diagnosis and the provision of end-of-life care or appropriate respiratory or nutritional support.Methods: Using the [hospital’s] database, records from 77 patients consulted consecutively in the MND clinic were obtained. Service parameters were compared against reference standards for diagnostic delay and treatment provision.Results: 84.4% of referrals came from neurologists outside of the MND service, with only 13% from general practitioners. On average, it took 14.7 months for patients to be seen in the MND clinic following symptom onset. Riluzole and percutaneous endoscopic gastrostomy (PEG) were prescribed faster in bulbar-onset versus limb-onset patients, by 4 times and 9 times respectively. End-of-life care discussion was recorded for 26% of patients.Conclusion: Diagnosing MND remains challenging for primary care physicians, which may be alleviated by disseminating recent Red Flag Committee guidelines. Investigation and treatment provision differed between MND subtypes, given the poorer prognosis associated with bulbar-onset. End-of-life care documentation remains low, which is an issue for the multi-disciplinary team (MDT) to resolve through incorporating palliative services.

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Health care utilization and patient-related outcomes in patients with malignant bowel obstruction admitted to a United States safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.50 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 50-50

Author(s):

Vijaya Venkatasubbaraya Pavan Kedar Vijaya Venkatasubbar Mukthinuthalapati ◽

Aakash Putta ◽

Ishaan Vohra ◽

Vatsala Katiyar ◽

Krishna Moturi ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

End Of Life ◽

Surgical Management ◽

End Of Life Care ◽

Safety Net ◽

Care Utilization ◽

Life Care ◽

Malignant Bowel Obstruction ◽

Safety Net Hospital

50 Background: Malignant bowel obstruction (MBO) and gastric outlet obstruction (GOO) can be a late complication of intra-abdominal malignancy with a poor prognosis. Most studies about its outcomes have focused on survival. There is paucity of studies assessing health care utilization and end of life care decisions. Methods: We retrospectively collected data from the electronic medical record of patients admitted with MBO or GOO at a safety-net hospital in Chicago, US between January 2013 and December 2017. The charts were analyzed for outcomes related to end of life care and health care utilization. The outcomes were compared by across three broad treatment arms: those that received surgical intervention, those that received venting gastrostomy (VG) and those that were treated medically alone. Results: Forty-six patients were identified of which 31 were admitted with MBO. 25 (54%) of them were due to stage IV cancers. Mean age of study population was 61 years. Surgical management, VG and medical management were done in 17, 8 and 21 patients respectively. There was no difference in ICU admission rate, length of stay of index admission, 90 day-readmission rate or mean visits to the ER between the groups. Patients receiving venting gastrostomy tube had highest rate of oral solid food tolerability. Twenty-eight patients died or were enrolled in hospice within a median of 115 days. Conclusions: All modalities of treatment had similar health utilization measures in patients with MBO and GOO. Surgical management, if feasible, has the longest time to hospice enrollment or death and should be offered to patients who are suitable. [Table: see text]

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