scholarly journals EP.FRI.468 A review of the management of malignant bowel obstruction at an NHS teaching hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jessica Banks ◽  
Sony Aiynattu ◽  
Rafik Ishak
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Peritoneal Metastasis ◽  
Palliative Surgery ◽  
Malignant Bowel Obstruction ◽  
Readmission Rates ◽  
Mortality And Morbidity ◽  
Clinical Dilemma ◽  
Complications And Mortality

Abstract Patients presenting with malignant bowel obstruction (MBO) due to peritoneal metastasis present a clinical dilemma for surgeons: although palliative surgery is beneficial, post-operative complications and mortality are as high as 30%.  A personalised and multi-disciplinary approach is paramount when treating these patients. Aims This study aimed to review the management (surgical versus conservative) of patients presenting with MBO; ascertain if a multi-disciplinary approach was adopted; and compare clinical outcomes including length-of-stay, readmission rates and mortality.  Methods All patients admitted with MBO secondary to peritoneal metastasis between January 2019 – January 2021 were identified. Results 29 patients; 14 females, were identified with a median age 72. The median length of stay was 16 days. All patients had a CT scan and 76% were performed within 24 hours of admission. 25/29 patients were referred to palliative care. Conclusions Overall mortality and morbidity in our cohort, regardless of surgical or conservative management, is consistent with existing literature. Palliative care input was sought for the majority of patients. Management decisions should be individualised and focus on ensuring the best quality of life for the patient. All decisions should be made with multi-disciplinary input. 

scholarly journals Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives

2020 ◽  
Vol 16 (8) ◽  
pp. 483-489
Author(s):  
Claire Hoppenot ◽  
Fay J. Hlubocky ◽  
Julie Chor ◽  
S. Diane Yamada ◽  
Nita K. Lee
Keyword(s):  
Palliative Care ◽  
Qualitative Analysis ◽  
Bowel Obstruction ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Malignant Bowel Obstruction ◽  
Specific Patient ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Nonsurgical Patients

PURPOSE: Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist’s approach to palliative care consultation in the setting of MBO has not been well studied—it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS: This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS: We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION: Participants’ expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.

scholarly journals Illness Understanding, Prognostic Awareness, and End-of-Life Care in Patients With GI Cancer and Malignant Bowel Obstruction With Drainage Percutaneous Endoscopic Gastrostomy

2020 ◽  
pp. OP.20.00035
Author(s):  
Jessica I. Goldberg ◽  
Debra A. Goldman ◽  
Sarah McCaskey ◽  
Douglas J. Koo ◽  
Andrew S. Epstein
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Malignant Bowel Obstruction ◽  
Do Not Resuscitate ◽  
Future Expectations ◽  
Endoscopic Gastrostomy ◽  
Gi Cancer ◽  
Additional Chemotherapy

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.

scholarly journals Management of Malignant Bowel Obstruction Associated With GI Cancers

2017 ◽  
Vol 13 (7) ◽  
pp. 426-434 ◽  
Author(s):  
Aaron J. Franke ◽  
Atif Iqbal ◽  
Jason S. Starr ◽  
Rajesh M. Nair ◽  
Thomas J. George
Keyword(s):  
Palliative Care ◽  
Peritoneal Carcinomatosis ◽  
Bowel Obstruction ◽  
Abdominal Cavity ◽  
Symptom Control ◽  
Disease Process ◽  
Terminal Phase ◽  
Malignant Bowel Obstruction ◽  
Gi Cancers

For many patients with GI malignancies, the seeding of the abdominal cavity with tumor cells, called peritoneal carcinomatosis, is a common mode of metastases and disease progression. Prognosis for patients with this aspect of their disease remains poor, with high disease-related morbidity and complications. Uniform and proven practices that provide optimal palliative care and quality of life for these patients are needed. The objective of this review is to critically assess the current literature regarding palliative strategies in the management of peritoneal carcinomatosis and associated symptoms in patients with advanced GI cancers. Despite encouraging results in the select population where cytoreductive surgery and intraperitoneal chemotherapy are indicated, the majority of patients who develop peritoneal carcinomatosis in the setting of GI cancers have poor prognosis, with malignant bowel obstruction representing a common terminal phase of their disease process. For all patients with peritoneal carcinomatosis, aggressive symptom control and early multimodality palliative care as further outlined should be sought.

scholarly journals Constipation and malignant bowel obstruction in palliative care

Medicine ◽  
2020 ◽  
Vol 48 (1) ◽  
pp. 18-22
Author(s):  
Jason W. Boland ◽  
Elaine G. Boland
Keyword(s):  
Palliative Care ◽  
Bowel Obstruction ◽  
Malignant Bowel Obstruction

scholarly journals A laparoscopic approach is associated with a decreased incidence of SSI in patients undergoing palliative surgery for malignant bowel obstruction

2017 ◽  
Vol 42 ◽  
pp. 90-94
Author(s):  
Yoshiaki Maeda ◽  
Toshiki Shinohara ◽  
Tomonari Katayama ◽  
Nozomi Minagawa ◽  
Masao Sunahara ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Laparoscopic Approach ◽  
Palliative Surgery ◽  
Malignant Bowel Obstruction

QIM19-127: Novel Admission Checklist for Malignant Bowel Obstruction

2019 ◽  
Vol 17 (3.5) ◽  
pp. QIM19-127
Author(s):  
Gabrielle Gauvin ◽  
Leigh Selesner ◽  
Marcin Chwistek ◽  
Molly Collins ◽  
Crystal Denlinger ◽  
...  
Keyword(s):  
Palliative Care ◽  
Bowel Obstruction ◽  
Multidisciplinary Team ◽  
Care Center ◽  
Tertiary Care ◽  
Management Plan ◽  
Care Plan ◽  
Malignant Bowel Obstruction ◽  
Goals Of Care ◽  
Nccn Guidelines

Background: Malignant bowel obstruction (MBO) is a frequent presentation of advanced abdominal malignancy. Despite the frequency of MBO and the availability of NCCN Guidelines for its management, clinicians struggle to create a personalized care plan accounting for a patient’s current condition, prognosis, and goals of care. The aim of this project is to develop a discussion tool to implement on admission to ensure realistic prognostication and appropriate involvement of the patient, caregivers, and multidisciplinary team in treatment decisions. Methods: At our tertiary care center, a multidisciplinary team composed of surgical oncologists, medical oncologists, palliative care specialists, hospitalists, social workers, and nutritionists developed an algorithm to implement when a patient is admitted with MBO. The algorithm was influenced by the NCCN Guidelines for palliative care but was designed as a single-page checklist that could be easily executed by all team members. Results: The MBO admission checklist is divided into 4 sections. The general assessment section includes information about the etiology, severity, and reversibility of the current and past MBO. Also, the patient’s resuscitation and functional status are reviewed. The cancer care coordination/communication section covers the patient’s oncological history and estimated lifespan, as well as the need for further coordination of care and a goals of care discussion. The subsequent portion covers the management plan, with specific decisions resulting from a goals of care discussion as well as the need for specialized consults. The medical, procedural, and operative interventions the team and patient discussed as options are also documented. A key portion is the risks and benefits discussion for each treatment modality. Lastly, the discussion about future considerations section explores the patient’s wishes for the next episode of MBO. Conclusions: The goal of this checklist is to ensure that a comprehensive discussion is held between the different services involved in a patient’s care at every admission for MBO in order to provide a personalized management plan and improve communication. The next step in our study is to assess the effectiveness of implementation of the checklist as well as its impact on patient satisfaction, quality of life, early hospice referral, and outcomes.

Bowel obstruction with stage IV cancer: The benefit of introduction of formal palliative care service.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20573-e20573
Author(s):  
Moshim Kukar ◽  
Adrienne Groman ◽  
Yashodhara K. Satchidanand ◽  
Amy I. Alvarez-Perez ◽  
Kelli B. Dunn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Comorbid Conditions ◽  
Stage Iv Cancer

e20573 Background: Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. The aim of this study was to evaluate the role of introduction of an organized palliative care service in the management of this complex disease process. Methods: We conducted a retrospective analysis of all patients admitted to the Roswell Park Cancer Institute with stage IV cancer and BO after the institution of formal palliative care service (PS) in 2009. This cohort was compared to a group prior to 2009 (No Palliative care service Group; NPS). The two groups were compared with respect to demographics, comorbid conditions, DNR status, laboratory parameters, medical, surgical management, length of stay and disposition status. Results: 28 patients were identified in PS group as compared to 40 patients in NPS group. The 2 groups were similar in terms of age, gender, race, comorbid conditions, primary site of cancer, chemotherapy, radiation therapy and weight loss. There was a statistically significant difference in the medication regimen provided, as those who had palliative care consults were more likely to receive alternative medications to standard anti-emetics (Table). The palliative care team followed 19/28 patients and 14/19 patients showed improvement in their symptoms (nausea, pain control) in initial 24 hours after the palliative care consult. 50 % ( n=14) of patients in PS group had a formal DNR order in place as compared to 15.4% in NPS group (p<0.001). In 9/14 patients the first discussion regarding DNR was held by palliative care team. A significantly higher percentage of patients were discharged to the hospice care in PS group (42.9% vs. 7.5%, p =0.006). Conclusions: BO in patients with stage IV cancer often poses a dilemma in the choice of surgery versus medical management. Palliative care consults, early in the hospitalization, may help improve symptom management, end of life discussions, better psychosocial support, discharge placements and will eventually translate to shorter length of stay. [Table: see text]

scholarly journals Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Claudio Lodoli ◽  
Marcello Covino ◽  
Miriam Attalla El Halabieh ◽  
Francesco Santullo ◽  
Andrea Di Giorgio ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Characteristic Curve ◽  
Prognostic Score ◽  
Palliative Surgery ◽  
Malignant Bowel Obstruction ◽  
Bowel Distension ◽  
Surgical Interventions ◽  
Patients At Risk ◽  
Surgical Failure

Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P &lt; 0.001), absence of bowel distension (P &lt; 0.001), and mesenteric involvement (P = 0.001) and retraction (P &lt; 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.

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