Is it safe to add cediranib to weekly paclitaxel chemotherapy in women with ovarian cancer who are at risk of developing malignant bowel obstruction?

158 Background: Malignant bowel obstruction (MBO) is a common and challenging clinical predicament in women with advanced gynecological cancers. However, there is a lack of evidence-based guidelines or innovative approaches to improve patient care and quality of life. We implemented an inter-professional MBO management program incorporating a nurse-led ambulatory symptom management algorithm and multidisciplinary care conferences (MCC) as hallmarks of this program. Methods: Princess Margaret Cancer Centre has piloted an inter-professional MBO management program that supports women with advanced gynecological cancers who are at risk of/have developed MBO. The MBO team includes oncologists (medical, surgical, gynecologic and radiation), palliative care physicians, diagnostic and interventional radiologists, home parenteral nutrition physicians, specialized oncology nurses, dietitians, pharmacists and social workers. Complex MBO cases are discussed at regular MCC to derive treatment consensus. A symptom-driven MBO management algorithm has been devised and all patients are educated with a personalized bowel symptom management and dietary plan. For outpatient care, patients with MBO are proactively monitored by our specialized oncology nurses via phone or an eHealth bowel application to facilitate communication of symptoms and early intervention. Access to community services and home palliative care services are utilized to support care at home. All patients are enrolled into a prospective database to assess care impact and quality. Results: A total of 145 patients have been followed through the MBO management program over 12 months. At time of data cutoff, 14 had MBO (3 inpatients and 11 outpatients) and 22 were deemed at risk of MBO. Majority patients are managed as an outpatient and avoided unnecessary emergency department episodes. Detailed methodology and data analyses will be presented. Conclusions: A successful novel MBO program incorporating inter-professional care model and nurse-led ambulatory symptom management algorithm optimizes patient care in this vulnerable population and foster collaboration in implementing best practice clinical processes.

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EDMONd: A feasibility study of elemental diet as an alternative to parenteral nutrition for ovarian cancer patients with inoperable malignant bowel obstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.tps5605 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. TPS5605-TPS5605

Author(s):

Agnieszka Michael ◽

Eleanor Smith ◽

Adele Hugg ◽

Thomas Kilpatrick

Keyword(s):

Ovarian Cancer ◽

Parenteral Nutrition ◽

Cancer Patients ◽

Feasibility Study ◽

Bowel Obstruction ◽

Elemental Diet ◽

Malignant Bowel Obstruction

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Malignant bowel obstruction in advanced ovarian cancer

Future Oncology ◽

10.2217/fon-2016-0431 ◽

2017 ◽

Vol 13 (6) ◽

pp. 513-521 ◽

Cited By ~ 8

Author(s):

Emma Dean ◽

Leila Khoja ◽

Andrew Clamp ◽

Gordon C Jayson ◽

Dilly Goonetilleke ◽

...

Keyword(s):

Ovarian Cancer ◽

Bowel Obstruction ◽

Advanced Ovarian Cancer ◽

Malignant Bowel Obstruction

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Screening tool for malignant bowel obstruction in relapsed, metastatic ovarian cancer

ESMO Open ◽

10.1136/esmoopen-2018-000463 ◽

2019 ◽

Vol 4 (2) ◽

pp. e000463 ◽

Cited By ~ 3

Author(s):

Robert D Morgan ◽

Sofia Stamatopoulou ◽

Nerissa Mescallado ◽

Geoff Saunders ◽

Richard Welch ◽

...

Keyword(s):

Ovarian Cancer ◽

Bowel Obstruction ◽

Clinical Symptoms ◽

Screening Tools ◽

Control Group ◽

Study Group ◽

Malignant Bowel Obstruction ◽

Screening Questionnaire ◽

Improve Risk Stratification ◽

Severity Scores

BackgroundMalignant bowel obstruction (MBO) is a common cause of morbidity and mortality in women diagnosed with ovarian cancer. Earlier detection of MBO may improve patient outcomes. There are currently no screening tools to assist detection.AimWe report a screening questionnaire that can be used to detect MBO, and how the severity score for key clinical symptoms correlate with radiological evidence of MBO from ovarian cancer.DesignA case–control study in which patients with relapsed, metastatic ovarian cancer were asked to answer 10 questions related to key clinical symptoms associated with intestinal obstruction. The study group included women with CT-confirmed MBO, whereas the control group had no evidence of MBO. Patients scored each question according to severity from 1 (least severe) to 5 (most severe).Setting/participantsBetween 1 June and 31 December 2016, 37 women completed the screening questionnaire.ResultsPatients in the study group (n=17) reported significantly higher (ie, more severe) scores for abdominal pain, nausea, vomiting and constipation. In contrast, differences in severity scores between groups did not differ significantly in response to questions regarding abdominal swelling, borborygmi, diarrhoea or loss of appetite. All patients in the study group more frequently stated that their symptoms had deteriorated within the 2 months prior to completing the questionnaire.ConclusionHere we report the key clinical symptoms associated with radiologically-confirmed MBO in relapsed, metastatic ovarian cancer. We recommend healthcare practitioners focus on these specific symptoms during patient consultations in order to improve risk stratification of MBO.

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Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2013.01.021 ◽

2013 ◽

Vol 129 (1) ◽

pp. 103-106 ◽

Cited By ~ 16

Author(s):

K.S. Rath ◽

D. Loseth ◽

P. Muscarella ◽

G.S. Phillips ◽

J.M. Fowler ◽

...

Keyword(s):

Ovarian Cancer ◽

Bowel Obstruction ◽

Tube Placement ◽

Malignant Bowel Obstruction ◽

Upper Gastrointestinal

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Malignant Bowel Obstruction in Relapsed Ovarian Cancer With Peritoneal Carcinomatosis: An Occlusive State

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001049 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1367-1372 ◽

Cited By ~ 8

Author(s):

Pedro Martinez Castro ◽

Lara Vargas ◽

Antonio Mancheño ◽

Salvador Martín Utrilla ◽

Francisco Pascual ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Peritoneal Carcinomatosis ◽

Bowel Obstruction ◽

First Episode ◽

Time Interval ◽

Short Time Interval ◽

Low Grade ◽

Malignant Bowel Obstruction ◽

Short Time

ObjectiveThe aim of this study was to describe the clinical and oncological outcomes of women with malignant bowel obstruction (MBO) for relapsed ovarian cancer and peritoneal carcinomatosis.MethodsA retrospective cohort study was performed in all consecutive patients admitted at Instituto Valenciano de Oncología, Valencia, Spain, between July 2013 and July 2016 with MBO for relapsed ovarian cancer and peritoneal carcinomatosis. All patients underwent the same protocol of conservative management. Surgical treatment was indicated only in selected cases.ResultsThere were a total of 22 patients presenting 59 episodes of MBO; 17 (77.2%) of those patients presented more than 1 episode of MBO. All patients had serous epithelial ovarian cancer; 18 (81.8%) were high grade, and 4 (18.2%) low-grade tumors. The median (range) number of episodes per patient was 3 (range, 1–7) with a mean length of hospitalization of 13 (SD, 13.6) days. The median time interval between episodes of MBO (54 episodes in 17 patients) was 17 days (range, 1–727 days). Twenty of 22 patients died with a median overall survival time from the first episode of MBO of 95 days (95% confidence interval, 49–124 days).ConclusionsPatients with MBO due to relapsed epithelial ovarian cancer in the peritoneal carcinomatosis setting have a short life expectancy, presenting a median of 3 episodes of MBO until death, with a short time interval between episodes. These findings show that bowel obstruction can represent a constant status over time until death.

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