Efficacy of Dexamethasone in the Management of Malignant Small Bowel Obstruction in Advanced Epithelial Ovarian Cancer

Introduction: Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, particularly in the terminal stages of the disease. Corticosteroids are used to promote symptom resolution in malignant small bowel obstruction (MSBO) related to EOC, with little published data on their efficacy, optimal dosing and duration of treatment.Objective: To evaluate the efficacy of dexamethasone in achieving symptom control in women with advanced EOC presenting with MSBO, assess dexamethasone dosing and efficacy over subsequent presentations, and examine differences in dexamethasone responsiveness between platinum resistant and platinum sensitive patient. Methods: This is a retrospective cohort study of women presenting with MSBO due to advanced EOC over a 12-year period from January 2005 to December 2016 in a single tertiary hospital.Results: Ninety-one women with MSBO were administered dexamethasone over 154 admissions with 89% of women initially achieving partial or complete symptom control. Dexamethasone responsiveness did not change with recurrent admissions and platinum responsive patients were more likely to respond to dexamethasone than platinum resistant patients (OR 3.6 [95%CI 1.1 to 12.2, p = 0.04]). 15.6% of patients required additional measures to control symptoms of MSBO and 44.8% had adequate symptoms resolution to allow them to remain on or commence further treatment for EOC. Conclusion: Dexamethasone therapy is a useful adjunctive therapy in the management of symptoms associated with MSBO in women with EOC.

Home parenteral nutrition in patients receiving palliative care: a curriculum-based review

Difficulty with maintaining nutritional intake is common in patients with cancer. European guidance suggests that wherever possible nutritional support should first be provided by the oral or enteral route. Where this is not possible, for example, in malignant small bowel obstruction, parenteral nutrition (PN) may be considered. In palliative care, it is generally accepted that the significant risks and burdens of PN outweigh the potential benefits in patients with an expected survival <2 months. Determining prognosis is crucial when helping patients to make decisions regarding appropriate care pathways; however, this remains challenging. An overview of clinical issues and prognostic indicators related to selecting patients appropriately for palliative PN is given to cover the relevant advanced competencies of the 2010 Gastroenterology Curriculum. The organisation of Home Parenteral Nutrition (HPN) services in England is described including the associated risks and burdens of HPN in the palliative patient.