Aim: Limited high-quality data exists to guide clinical management of malignant bowel obstruction (MBO) in advanced cancer patients. This study aims to describe the scope and success of inpatient care of MBO in an Australian tertiary referral hospital to identify areas of unmet need.
Method: This retrospective review included all adult, advanced malignancy patients with a MBO admitted under Oncology or General Surgical units at The Canberra Hospital between 1st January 2015 - 31st December 2019. Details on patient demographics, cancer history, inpatient treatment and outcomes were collected from electronic records and analysed using descriptive statistics.
Results: 116 eligible patients were identified, with the majority (72%) admitted under Medical Oncology. The most common malignancies were gynaecological (31%), colorectal (26%) and upper gastrointestinal (23%). Most patients received bowel rest, intravenous fluids (~99%) and a variety of pharmacological agents to manage symptoms. 18 patients underwent surgery and 10 underwent endoscopic procedures to manage their MBO. 56% had Specialist Palliative Care input, which more often lead to documentation of consideration of psychosocial needs and preferred place of death. A majority (59%) were discharged home, with a short median overall survival of 61 days (95% CI, 18-103). A lower proportion (33%) of those who underwent surgery went directly home. On discharge from hospital, 86% had some improvement in pain, 86% had improvement in vomiting and 44% had improvement in their bowel habits.
Conclusion: MBO is associated with a poor prognosis in advanced malignancy. Most patients were managed conservatively, with interventional approaches uncommon. Results suggest that management generally lead to some improvement in symptoms. Early involvement of Specialist Palliative Care may facilitate a more holistic management of MBO. Future research should explore patient reported experiences and treatment goals, prospective assessment of pharmacological medications to manage symptoms and approaches to patient selection for interventions.