Multidisciplinary Management of Malignant Bowel Obstruction in Patients with Advanced Gynecological Cancers

Abstract

Background

Malignant bowel obstruction (MBO) is a debilitating complication in advanced gynecological cancers, often leading to frequent emergency visits, prolonged hospitalization and poor survival outcomes.

Methods

A prospective study was conducted to assess implementation of a proactive MBO model of care (MOC) using a clinical risk-based triage system which includes standardized bowel function assessment tools, a bowel management regime, and education tools for patients and nurses. Management followed a defined algorithm, supported by an interdisciplinary team (IDT) comprising of oncologists, specialized oncology nurses (RN), surgeons, gastroenterologists, radiologists, palliative care specialists, and dietitians. Patients “at risk” of MBO received RN proactive phone calls to manage symptoms for up to 4 weeks. Patients with MBO, IDT informed treatment decisions, including inpatient interventions or ambulatory management, with continued RN proactive phone call management for 8 weeks. The objective was to optimize interdisciplinary management of MBO.

Results

We enrolled 92 patients, with 49% (n=45) presenting with MBO and 51% (n=47) classified as "at risk". Proactive outpatient management by RN led to symptom resolution in 93% of "at-risk" patients, with 7% progressing. Throughout the study, 62% (n=57) of patients experienced MBO, of which 93% (n=53) required inpatient management. All patients were discussed in IDT rounds. Surgical intervention was performed in 11% (n=6) of patients, and 77% (n=44) received chemotherapy. MBO resolution occurred in 42% (n=24) of patients within 60 days. 11% (n=6) experienced recurrent MBO episodes, and 58% (n=33) had persistent symptoms. The median hospitalization durations were 7 days (range, 0–30) and 12.5 days (range, 0–57) within the first 30 and 60 days after MBO diagnosis respectively. The ratio of days alive and out of the hospital within 60 days was 0.3 (range, 0–19).

Conclusions

This study demonstrates the feasibility of a proactive MBO MOC in an ambulatory setting, with most patients effectively managed as an outpatient with interdisciplinary support, resulting in reduced hospitalization.