Medical Management of Inoperable Malignant Bowel Obstruction

2020 ◽  
pp. 106002802097977
Author(s):  
Xiaoyan Huang ◽  
Jing Xue ◽  
Min Gao ◽  
Qiyuan Qin ◽  
Tenghui Ma ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Effects ◽  
Bowel Obstruction ◽  
Medical Management ◽  
Case Reports ◽  
Somatostatin Analogs ◽  
Clinical Approach ◽  
Malignant Bowel Obstruction ◽  
Anti Inflammatory

Objective: To review medical management of inoperable malignant bowel obstruction. Data Sources: A literature review using PubMed and MEDLINE databases searching malignant bowel obstruction, etiology, types, pathophysiology, medical, antisecretory, anti-inflammatory, antiemetic drugs, analgesics, promotion of emptying, prevention of infection, anticholinergics, somatostatin analogs, gastric antisecretory drugs, prokinetic agents, glucocorticoid, opioid analgesics, antibiotics, enema, and adverse effects. Study Selection and Data Extraction: Randomized or observational studies, cohorts, case reports, or reviews written in English between 1983 and November 2020 were evaluated. Data Synthesis: Malignant bowel obstruction (MBO) commonly occurs in patients with advanced or recurrent malignancies and severely affects the quality of life and survival of patients. Its management remains complex and variable. Medical management is the cornerstone of MBO treatment, with the goal of reducing distressing symptoms and optimizing quality of life. Until now, there has been neither a standard clinical approach nor registered medications to treat patients with inoperable MBO. Relevance to Patient Care and Clinical Practice: This review provides information on the etiology, type and pathophysiology, and medical treatment of MBO and related adverse reactions of the drugs commonly used, which can greatly assist clinicians in making clinical decisions when treating MBO. Conclusions: Published research shows that medical management of MBO mainly consists of antisecretory, anti-inflammatory strategies, controlling vomiting and pain, promoting emptying, preventing infection, and combination therapy. Being knowledgeable about the most current treatment options, the related adverse effects, and the evidence supporting different practices is critical for clinicians to provide individualized medical therapy for MBO patients.

scholarly journals Astragalus polysaccharide (PG2) Ameliorates Cancer Symptom Clusters, as well as Improves Quality of Life in Patients with Metastatic Disease, through Modulation of the Inflammatory Cascade

Cancers ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1054 ◽  
Author(s):  
Wen-Chien Huang ◽  
Kuang-Tai Kuo ◽  
Oluwaseun Adebayo Bamodu ◽  
Yen-Kuang Lin ◽  
Chun-Hua Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Growth Factor ◽  
Adverse Effects ◽  
Metastatic Disease ◽  
Controlled Trial ◽  
High Dose ◽  
Advanced Stage ◽  
Gm Csf ◽  
Anti Inflammatory

Background: Improving patients’ quality of life (QoL) is a principal objective of all treatment in any clinical setting, including oncology practices. Cancer-associated inflammation is implicated in disease progression and worsening of patients’ QoL. Conventional anticancer therapeutics while selectively eliminating cancerous cells, are evaded by stem cell-like cells, and associated with varying degrees of adverse effects, thus reducing patients’ QoL. This necessitates novel therapeutic approaches with enhanced efficacy, minimal or no treatment-related adverse effects, and improved QoL in patients with cancer, especially those with metastatic/advance stage disease. Methods: Sequel to our team’s previous publication, the present study explores probable effects of Astragalus polysaccharides (PG2) on cancer-related inflammatory landscape and known determinants of QoL, as well as the probable link between the two to provide mechanistic insight. In an exploratory double blind randomized controlled trial using patients with metastatic disease (n = 23), we comparatively evaluated the therapeutic efficacy of high (500 mg) or low (250 mg) dose PG2 administered intravenously (i.v.), with particular focus on its suggested anti-inflammatory function and the probable effect of same on QoL indices at baseline, then at weeks 4 and 8 post-PG2 treatment. Results: All 23 patients with metastatic disease treated with either low or high PG2 experienced reduced pain, nausea, vomiting, and fatigue, as well as better appetite and sleep, culminating in improved global QoL. This was most apparent in the high dose group, with significant co-suppression of pro-inflammatory interleukin (IL)-1β, IL-4, IL-6, IL-13, IL-17, monocytes chemotactic protein (MCP)1, granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF), tumor growth factor (TGF)-β1, interferon (IFN)-γ, and immune suppressors IL-10 and IL-12. Univariate and multivariate analyses revealed that IL-1β, IL-13 and GM-CSF are independent prognosticators of improved QoL. Conclusion: This proof-of-concept study provides premier evidence of functional association between PG2 anti-inflammatory effects and improved QoL in patients with advanced stage cancers, laying the groundwork for future larger cohort blinded controlled trials to establish the efficacy of PG2 as adjuvant anticancer therapy in metastatic or advanced stage clinical settings.

scholarly journals Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Yeh Chen Lee ◽  
Nazlin Jivraj ◽  
Catherine O’Brien ◽  
Tanya Chawla ◽  
Eran Shlomovitz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bowel Obstruction ◽  
Treatment Guidelines ◽  
Clinical Trial Design ◽  
Major Complication ◽  
Evidence Based ◽  
Malignant Bowel Obstruction ◽  
Gynecologic Cancers ◽  
The Impact

Malignant bowel obstruction (MBO) is a major complication in women with advanced gynecologic cancers which imposes a significant burden on patients, caregivers, and healthcare systems. Symptoms of MBO are challenging to palliate and result in progressive decompensation of already vulnerable patients with limited therapeutic options and a short prognosis. However, there is a paucity of guidelines or innovative approaches to improve the care of women who develop MBO. MBO is a complex clinical situation that requires a multidisciplinary approach to ensure the appropriate treatment modality and interprofessional care to optimally manage these patients. This review summarizes the current literature on the different approaches targeting MBO management including surgical intervention, chemotherapy, total parenteral nutrition, and pharmacological treatment. In addition, the impact of MBO management on patients’ quality of life (QOL) is examined. This article focuses on the challenges in developing evidence-based treatment guidelines for MBO and barriers in clinical trial design for MBO and proposes strategies to advance the MBO management. Collaboration is essential to design studies that may improve the overall care and quality of life for these patients. Prospective data are needed to inform clinical practice, establish a new benchmark for evidence-based MBO management, and better understand the biology of MBO.

Bowel Management

2019 ◽  
pp. 186-205
Author(s):  
Stefanie N. Mooney ◽  
Purvi Patel ◽  
Sorin Buga
Keyword(s):  
Quality Of Life ◽  
Supportive Care ◽  
Liver Failure ◽  
Bowel Obstruction ◽  
Gastrointestinal Symptoms ◽  
Malignant Bowel Obstruction ◽  
Nursing Assessment ◽  
Bowel Management ◽  
Assessment And Treatment

This chapter reviews palliative considerations for bowel management in a patient with advanced disease such as cancer, liver failure, AIDS, or general debility. In particular, it discusses the definition, prevalence, pathophysiology, assessment, and management of gastrointestinal symptoms common in the palliative population, including constipation and diarrhea. It also reviews malignant bowel obstruction and ascites and how these may impact quality of life for patients with life-limiting illness. The discussion of management includes both pharmacologic approaches and supportive care options. This information is designed to help guide nursing assessment and treatment of bowel management, as well as provide useful insight to any clinical provider encountering these conditions.

Room for improvement? A quality-of-life assessment in patients with malignant bowel obstruction

2009 ◽  
Vol 24 (1) ◽  
pp. 38-45 ◽  
Author(s):  
D. Selby ◽  
F. Wright ◽  
K. Stilos ◽  
P. Daines ◽  
V. Moravan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bowel Obstruction ◽  
Life Assessment ◽  
Malignant Bowel Obstruction ◽  
Quality Of Life Assessment

scholarly journals Health-related quality of life in patients with inoperable malignant bowel obstruction: secondary outcome from a double-blind, parallel, placebo-controlled randomised trial of octreotide

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nikki McCaffrey ◽  
Tegan Asser ◽  
Belinda Fazekas ◽  
Wendy Muircroft ◽  
Meera Agar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bowel Obstruction ◽  
Nausea And Vomiting ◽  
Trial Registration ◽  
Malignant Bowel Obstruction ◽  
Health Related Quality ◽  
Double Blind ◽  
Related Quality ◽  
Health Related

Abstract Background This analysis aims to evaluate health-related quality of life (HrQoL) (primary outcome for this analysis), nausea and vomiting, and pain in patients with inoperable malignant bowel obstruction (IMBO) due to cancer or its treatments randomised to standardised therapies plus octreotide or placebo over a maximum of 72 h in a double-blind clinical trial. Methods Adults with IMBO and vomiting recruited through 12 services spanning inpatient, consultative and community settings in Australia were randomised to subcutaneous octreotide infusion or saline. HrQoL was measured at baseline and treatment cessation (EORTC QLQ-C15-PAL). Mean within-group paired differences between baseline and post-treatment scores were analysed using Wilcoxon Signed Rank test and between group differences estimated using linear mixed models, adjusted for baseline score, sex, age, time, and study arm. Results One hundred six of the 112 randomised participants were included in the analysis (n = 52 octreotide, n = 54 placebo); 6 participants were excluded due to major protocol violations. Mean baseline HrQoL scores were low (octreotide 22.1, 95% CI 14.3, 29.9; placebo 31.5, 95% CI 22.3, 40.7). There was no statistically significant within-group improvement in the mean HrQoL scores in the octreotide (p = 0.21) or placebo groups (p = 0.78), although both groups reported reductions in mean nausea and vomiting (octreotide p < 0.01; placebo p = 0.02) and pain scores (octreotide p < 0.01; placebo p = 0.03). Although no statistically significant difference in changes in HrQoL scores between octreotide and placebo were seen, an adequately powered study is required to fully assess any differences in HrQoL scores. Conclusion The HrQoL of patients with IMBO and vomiting is poor. Further research to formally evaluate the effects of standard therapies for IMBO is therefore warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000211369 (date registered 18/04/2008)

scholarly journals Astragalus Polysaccharide (PG2) Ameliorates Cancer Symptom Clusters, as Well as Improves Quality of Life in Patients with Metastatic Disease, Through Modulation of the Inflammatory Cascade

2019 ◽  
Author(s):  
Wen-Chien Huang ◽  
Kuang-Tai Kuo ◽  
Oluwaseun Adebayo Bamodu ◽  
Yen-Kuang Lin ◽  
Chun-Hua Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Growth Factor ◽  
Adverse Effects ◽  
Metastatic Disease ◽  
Controlled Trial ◽  
High Dose ◽  
Advanced Stage ◽  
Gm Csf ◽  
Anti Inflammatory

Background: Improving patients&rsquo; quality of life (QoL) is a principal objective of all treatment in any clinical setting, including oncology practice. Cancer-associated inflammation is implicated in disease progression and worsening of patients&rsquo; QoL. Conventional anticancer therapeutics while selectively eliminating cancerous cells, are evaded by stem cell-like cells, and associated with varying degrees of adverse effects, thus reducing patients&rsquo; QoL. This necessitates novel therapeutic approaches with enhanced efficacy, minimal or no treatment-related adverse effects, and improved QoL in patients with cancer, especially those with metastatic/advance stage disease. Methods: Sequel to our team&rsquo;s previous publication, the present study explores probable effects of Astragalus polysaccharides (PG2) on cancer-related inflammatory landscape and known determinants of QoL, as well as the probable link between the two to provide mechanistic insight. In exploratory double blind randomized controlled trial using patients with metastatic disease (n=23), we comparatively evaluated the therapeutic efficacy of high (500mg) or low (250mg) dose PG2 administered intravenously (i.v.), with particular focus on its suggested anti-inflammatory function and the probable effect of same on QoL indices at baseline, then at weeks 4 and 8 post-PG2 treatment. Results: All 23 patients with metastatic disease treated with either low or high PG2 experienced reduced pain, nausea, vomiting and fatigue, as well as better appetite and sleep, culminating in improved global QoL. This was most apparent in the high dose group, with significant co-suppression of pro-inflammatory interleukin (IL)-1&beta;, IL-4, IL-6, IL-13, IL-17, monocytes chemotactic protein (MCP)1, granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF), tumor growth factor (TGF)-&beta;1, interferon (IFN)-&gamma;, and immune suppressors IL-10, and IL-12. Univariate and multivariate analyses revealed that IL-1&beta;, IL-13 and GM-CSF are independent prognosticators of improved QoL. Conclusion: This proof-of-concept study provides premier evidence of functional association between PG2 anti-inflammatory effects and improved QoL in patients with advanced stage cancers, laying the groundwork for future larger cohort blinded controlled trials to establish the efficacy of PG2 as adjuvant anticancer therapy in metastatic or advanced stage clinical settings.

Stroke Following Successful PTMC in a Patient with Severe Mitral Stenosis: A Case Report and Presenting A Simple Stepwise Approach to PTMC-related Stroke

2020 ◽  
Vol 20 (3) ◽  
pp. 232-236
Author(s):  
Mohammad H. Namazi ◽  
Isa Khaheshi ◽  
Alireza Kaveh ◽  
Fatemeh Taherian ◽  
Mohammadreza Naderian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Adverse Effects ◽  
Unusual Complication ◽  
Clinical Approach ◽  
Stepwise Approach ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Mitral Commissurotomy

Stroke following percutaneous trans-septal mitral commissurotomy (PTMC) is an unusual complication that could significantly affect the quality of life of the patients, particularly the young and active ones. We present a middle-aged woman who experienced stroke following PTMC and successfully treated with thrombolytic therapy regarding the potential adverse effects of this type of therapy. Also, we present a simple novel stepwise clinical approach for PTMC-related stroke.

Octreotide improved the quality of life in a child with malignant bowel obstruction caused by peritoneal dissemination of colon cancer

2007 ◽  
Vol 42 (1) ◽  
pp. 259-260 ◽  
Author(s):  
Hideki Watanabe ◽  
Yasuhiro Inoue ◽  
Keiichi Uchida ◽  
Yoshinaga Okugawa ◽  
Junichiro Hiro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Bowel Obstruction ◽  
Peritoneal Dissemination ◽  
Malignant Bowel Obstruction
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