From the Journals

Pilot program benefits gynecologic cancer patients with malignant bowel obstruction



A pilot program that aims to optimize the care of patients with malignant bowel obstruction is associated with longer survival and shorter cumulative hospital length of stay in the first 60 days after a malignant bowel obstruction diagnosis, according to research published in Journal of Oncology Practice.

Yeh Chen Lee, MBBS, of Princess Margaret Cancer Centre in Toronto, and colleagues retrospectively compared the outcomes of 106 women with advanced gynecologic cancer who were admitted to the hospital with malignant bowel obstruction before the program was implemented, with those of 63 women who were admitted after the program was implemented.

Patients’ median age at diagnosis of malignant bowel obstruction was 62 years (range, 31-91 years). Primary cancer diagnoses included ovarian cancer (73%), uterine cancer (18%), and cervical cancer (9%), and most patients had stage III-IV disease. Most patients had small-bowel obstruction (78%).

In the 2 years before the program, women had an average cumulative length of stay in the hospital of 22 days within the first 60 days of malignant bowel obstruction diagnosis. In the 2 years after, the average length of stay was 13 days. Furthermore, median overall survival, adjusted for initial cancer stage and lines of chemotherapy, increased by about 5 months, from 99 days before the program to 243 days after the program was implemented.

Patients who were treated during the malignant bowel obstruction program were more likely than were patients in the baseline group to receive chemotherapy (83% vs. 56%) and to receive two or more interventions for malignant bowel obstruction, such as surgery, chemotherapy, or total parenteral nutrition (42% vs. 33%). Complications included bowel perforation (13% in the program group vs. 5% in the baseline group) and fistulizing disease (6% in the program group vs. 12% in the baseline group).

In addition, the program was associated with lower costs.

The pilot program was designed “to provide a systematic framework to coordinate care and consensus decision-making among different specialties relevant to [malignant bowel obstruction] management,” Dr. Lee and colleagues said. It includes outpatient care led by oncology nurses through telephone consultations. “Standardized clinical processes, assessment tools, and documentation in the electronic medical record are incorporated to facilitate seamless transition between in- and outpatient care,” the authors said. “Patient educational materials have been developed to empower patients to recognize and effectively communicate their symptoms.”

It is unclear whether other institutions could implement this program, Dr. Lee and colleagues noted. It also is not possible to determine whether differences in survival relate to earlier recognition of malignant bowel obstruction, more effective management, or other factors.

Dr. Lee was supported by funding from Princess Margaret Cancer Foundation and an Australian Government Research Training Program Scholarship. Coauthors disclosed financial relationships with pharmaceutical companies and pending patents related to percutaneous procedures and a surgical device.

SOURCE: Lee YC et al. J Oncol Pract. 2019 Sep 24. doi: 10.1200/JOP.18.00793.

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