e-Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Factors affecting survival in patients with malignant bowel obstruction receiving palliative care input: a single centre retrospective study (#371)

Melani Mahendran 1 , Rajesh Aggarwal 2 3 4 5 6 , Melinda Van Leeuwen 1 , Shamira Cross 7 , Deme Karikios 8 9
  1. Palliative Medicine, Nepean Hospital, NBMLHD
  2. Palliative Medicine, Bankstown-Lidcombe Hospital, SWSLHD
  3. Renal Supportive Care, SWSLHD
  4. Faculty of Medicine, University of New South Wales
  5. Trials Management Committee, Palliative Care Clinical Studies Collaborative
  6. Ingham Institute, Sydney
  7. Radiation Oncology, Nepean Hospital, NBMLHD
  8. Medical Oncology, Nepean Hospital, NBMLHD
  9. Sydney Medical School, University of Sydney, Sydney

Aim:

To determine factors that predict poor survival in patients admitted with malignant bowel obstruction receiving palliative care input.

 

Method:

A retrospective audit was conducted of patients admitted with malignant bowel obstruction, who received palliative care team involvement at a Western Sydney Hospital from January 2015 to June 2021. Data was collected from an internal Palliative Care databank and patient medical records. Survival outcomes were divided into two groups: ≤1 month and >1 month. Poor survival was defined as ≤1 month.

 

Results:

In this cohort of 78 patients, the median age was 70 years. There were 26 patients with upper gastrointestinal cancers, 20 with colorectal cancers, 6 with gynaecological cancers and 26 patients with other cancers. In this cohort, 35 patients had ≤1 month survival and 43 had >1 month survival.

Patient characteristics on admission that were found to be significant in predicting poor survival on univariate analysis were opioid use (27 (74.3%) vs 19 (44.2%) p = 0.01) and poor performance status (ECOG 3 and 4) (18 (51.4%) vs 11 (25.6%) p = 0.03). The presence of peritoneal disease was also suggestive of poor survival, however this was not significant.

The only significant treatment factor that was associated with poor survival was the use of Levomepromazine (11 (31.4%) vs 5 (11.6%) p = 0.047). No association with poor survival was found with nasogastric tube insertion, surgical intervention, use of dexamethasone, anti-secretory agents, or other antiemetics. After adjusting for age and relevant confounding factors on multivariate analysis, opioid use was the only factor that was significantly associated with poor survival.

 

Conclusion:

Opioid use on admission was associated with poor survival. A larger cohort study would be beneficial in determining the association between treatment options and survival in patients with malignant bowel obstruction.