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Allan LL, Skene SS, Eastley KB, Herbertson R, Smith E, Michael A. Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of elemental diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer. Support Care Cancer 2024; 32:567. [PMID: 39093327 PMCID: PMC11297088 DOI: 10.1007/s00520-024-08709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/01/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Nutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if the prognosis is > 2 months. An elemental diet (ED) is licensed for strictures in Crohn's disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a proof of concept of ED as an acceptable feeding option. METHODS This was a mixed-methods single-arm feasibility study. The primary endpoint was to provide a 'proof of concept' of ED as an acceptable feeding option for patients with IBO. Secondary endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, the number of cartons drunk, quality of life (QOL) and the number of women treated with chemotherapy. Patients (> 18 years) with CT-confirmed IBO who could tolerate 500 ml of liquid in 24 h remained on the trial for 2 weeks. RESULTS A total of 29 patients were recruited; of those, 19 contributed to the analysis for the primary endpoint; 13 (68.4%) participants tolerated the ED; 26 patients contributed to MSAS and EORTC QLQ questionnaires at baseline to allow for the assessment of symptoms. At the start of the study, 18 (69%) of patients experienced vomiting, reducing to 4 (25%) by the end of day 15 of the study; 24 (92%) of patients reported pain at consent, reducing to 12 (75%) by the end of day 15. QOL scores improved from 36.2 (95% CI 27.7-44.7) at baseline to 53.1 (95% CI 40.3-66) at the end of day 15; 16 (84%) participants commenced chemotherapy within the first week of starting ED. The number of cartons across all participants showed a median of 1.3 cartons per day (range 0.8 to 2.5). CONCLUSION ED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.
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Affiliation(s)
- Lindsey L Allan
- Royal Surrey NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, United Kingdom
| | - Simon S Skene
- Surrey Clinical Trials Unit, School of Biosciences, University of Surrey, Egerton Road, Guildford, GU2 7XP, United Kingdom
| | - Kate Bennett Eastley
- Surrey Clinical Trials Unit, School of Biosciences, University of Surrey, Egerton Road, Guildford, GU2 7XP, United Kingdom
| | - Rebecca Herbertson
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex Hospital, Eastern Road, Brighton, BN2 5BE, United Kingdom
| | - Eleanor Smith
- Royal Surrey NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, United Kingdom
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, United Kingdom.
- Surrey Clinical Trials Unit, School of Biosciences, University of Surrey, Egerton Road, Guildford, GU2 7XP, United Kingdom.
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2
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Wall JA, Pozzar RA, Enzinger AC, Tavormina A, Howard C, Matulonis UA, Liu JF, Horowitz N, Meyer LA, Wright AA. Improving the palliative-procedure decision-making process for patients with peritoneal carcinomatosis: A secondary analysis. Gynecol Oncol 2024; 188:125-130. [PMID: 38954989 DOI: 10.1016/j.ygyno.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/21/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Peritoneal carcinomatosis (PC) is common in patients with advanced gynecologic and gastrointestinal cancers. Frequently, patients with PC undergo palliative surgery or procedures to manage disease-related complications and side effects. However, there are limited data regarding patients' and family caregivers' decision-making processes about these procedures. Thus, we sought to describe the decision-making experiences of patients with PC who elect to pursue palliative surgical procedures and their family caregivers. METHODS We conducted a secondary analysis of qualitative data collected during a pilot randomized controlled trial of BOLSTER, a nurse-led telehealth intervention for patients with PC and their caregivers after an acute hospitalization and palliative procedure. Participants in both study arms described their experiences in semi-structured interviews. We re-analyzed coded qualitative data with a focus on understanding decision-making experiences surrounding palliative surgery and procedures using conventional content analysis. RESULTS Interviews from 32 participants, 23 patients and 9 caregivers, were analyzed. Participants reported their decision-making was complicated by illness uncertainty and a desire for clear, effective communication with surgical and medical oncology teams. Participants requested more information about the impact of palliative procedures on their daily life. Several also noted that, without improved understanding, a misalignment between patient and family caregiver goals and palliative procedures may inadvertently increase suffering. CONCLUSION Discussions related to patients' goals and preferences can improve the quality of treatment decision-making in patients with PC and their caregivers. Future research should test interventions to improve advanced cancer patients' illness understanding and decision-making surrounding palliative surgery and procedures.
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Affiliation(s)
- Jaclyn A Wall
- University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Andrea C Enzinger
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | | | - Ursula A Matulonis
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joyce F Liu
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Neil Horowitz
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Larissa A Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alexi A Wright
- Dana-Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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3
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Gaughan S, Williams M. The holistic management of malignant bowel obstruction in women with advanced ovarian cancer at end of life. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:550-555. [PMID: 37344127 DOI: 10.12968/bjon.2023.32.12.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Bowel obstruction is commonly a pre-terminal event in women with advanced ovarian cancer. Management of symptoms will often be the focus rather than surgical intervention. Determining the patient's end-of-life wishes is paramount - because the prognosis for these patients can be short, advanced care planning is key. This case study will explore the management of nausea and vomiting associated with malignant bowel obstruction and demonstrate how a patient's psychological and social wellbeing is as important as managing the physical symptoms. It will discuss how skilled and effective communication is vital early in the disease trajectory in ensuring the patient's needs are met. Additionally, by undertaking a thorough holistic needs assessment, all aspects of end-of-life care can be discussed with the patient and family, which may enable the achievement of a preferred place of care and a peaceful, dignified death. Multidisciplinary working and co-ordination of care may allow for quick interventions, meeting individual needs and symptoms being managed more effectively.
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Affiliation(s)
- Sarah Gaughan
- Macmillan Lung and Rarer Clinical Nurse Specialist and Team Lead, Buckinghamshire Hospitals NHS Trust: Aylesbury
| | - Mary Williams
- Senior Lecturer in Cancer, Palliative and End of Life Care, Buckinghamshire New University, High Wycombe
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4
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Joost K, Washington K, Faurot M, Alexander RL, Craig KW, Tuller ER. Identifying the palliative care needs of patients and families in gynecologic surgical oncology: A scoping review. J Psychosoc Oncol 2023; 41:732-743. [PMID: 36752067 DOI: 10.1080/07347332.2023.2174474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Patients undergoing oncology-related gynecologic surgical procedures experience substantial symptom burden and distress. Support from specialist palliative care teams may benefit these patients and their families; however, an evidence-informed approach to the integration of palliative care and gynecologic surgical oncology is needed. To inform such an approach, a scoping review synthesizing current evidence on the palliative care needs of patients and families in gynecologic surgical oncology was conducted.Methods: Reviewers performed a structured search of online databases CINAHL, Scopus, PsycINFO, MEDLINE, and PubMed in addition to the grey literature to identify relevant studies published between 2011 and June 11th, 2021. The original search identified 993 articles, which were dually screened for study inclusion, resulting in a final sample of articles from which data were systematically extracted and synthesized.Results: This review of 59 publications predominantly consisted of European studies (n = 26, 44.1%), described quantitative study methods (n = 47, 79.6%), followed an observational study design (n = 49, 83.1%), and focused on psychological impact of treatment as a major topic of study (n = 21, 35.6%). The dataset also described sexual function of women post treatment (n = 15, 25.4%), quality of life (n = 10, 16.9%), therapeutic decision making (n = 9, 15.2%), pain assessment (n = 2, n = 3.6%), and medication for symptom management (n = 2, 3.6%). Explicit discussion of specialist palliative care involvement was rare.Conclusion: The needs of patients and families in gynecologic surgical oncology are well-suited to palliative care collaboration; however, the body of literature on palliative care services provided to this unique population is underdeveloped.
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Affiliation(s)
- Klaudia Joost
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Karla Washington
- Division of Palliative Medicine, Washington University, St. Louis, Missouri, USA
| | - Mary Faurot
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | | | - Kevin W Craig
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Erin R Tuller
- School of Medicine, University of Missouri, Columbia, Missouri, USA
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Baddeley E, Mann M, Bravington A, Johnson MJ, Currow D, Murtagh FEM, Boland EG, Obita G, Oliver A, Seddon K, Nelson A, Boland JW, Noble SIR. Symptom burden and lived experiences of patients, caregivers and healthcare professionals on the management of malignant bowel obstruction: A qualitative systematic review. Palliat Med 2022; 36:895-911. [PMID: 35260004 PMCID: PMC9174615 DOI: 10.1177/02692163221081331] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Malignant bowel obstruction occurs in up to 50% of people with advanced ovarian and 15% of people with gastrointestinal cancers. Evaluation and comparison of interventions to manage symptoms are hampered by inconsistent evaluations of efficacy and lack of agreed core outcomes. The patient perspective is rarely incorporated. AIM To synthesise the qualitative data regarding patient, caregiver and healthcare professionals' views and experience of malignant bowel obstruction to inform the development of a core outcome set for the evaluation of malignant bowel obstruction. DESIGN A qualitative systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (https://www.crd.york.ac.uk/prospero, CRD42020176393). DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus databases were searched for studies published between 2010 and 2021. Reference lists were screened for further relevant publications, and citation tracking was performed. RESULTS Nine papers were included, reporting on seven studies which described the views and experiences of malignant bowel obstruction through the perspectives of 75 patients, 13 caregivers and 62 healthcare professionals. Themes across the papers included symptom burden, diverse experiences of interventions, impact on patient quality of life, implications and trajectory of malignant bowel obstruction, mixed experience of communication and the importance of realistic goals of care. CONCLUSION Some of the most devastating sequelae of malignant bowel obstruction, such as pain and psychological distress, are not included routinely in its clinical or research evaluation. These data will contribute to a wider body of work to ensure the patient and caregiver perspective is recognised in the development of a core outcome set.
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Affiliation(s)
- Elin Baddeley
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Mala Mann
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK.,Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Alison Bravington
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - David Currow
- University of Technology Sydney, Sydney, NSW, Australia
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Elaine G Boland
- Queens Centre for Oncology and Haematology, Cottingham, Hull, UK
| | | | - Alfred Oliver
- National Cancer Research Institute, Consumer Liaison Group; Trans-Humber Consumer Research Panel, London, UK
| | - Kathy Seddon
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Simon I R Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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Madariaga A, Lau J, Ghoshal A, Dzierżanowski T, Larkin P, Sobocki J, Dickman A, Furness K, Fazelzad R, Crawford GB, Lheureux S. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer 2022; 30:4711-4728. [PMID: 35274188 PMCID: PMC9046338 DOI: 10.1007/s00520-022-06889-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. METHODS The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions. RESULTS The systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided. CONCLUSION This MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.
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Affiliation(s)
- Ainhoa Madariaga
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.,Autonomous University of Barcelona, Barcelona, Spain.,12 Octubre University Hospital, Madrid, Spain
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Arunangshu Ghoshal
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - Tomasz Dzierżanowski
- Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Philip Larkin
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Andrew Dickman
- Academic Palliative and End of Life Care Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England, UK
| | - Kate Furness
- Department of Dietetics, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Rouhi Fazelzad
- Library and information services, University of Health Network, Toronto, Canada
| | - Gregory B Crawford
- Northern Adelaide Palliative Service, Northern Adelaide Local Health Network, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Stephanie Lheureux
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
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7
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Hoppenot C, Hlubocky FJ, Chor J, Yamada SD, Lee NK. Gaps in patient-physician communication at the time of malignant bowel obstruction from recurrent gynecologic cancer: a qualitative study. Support Care Cancer 2021; 30:367-376. [PMID: 34287689 DOI: 10.1007/s00520-021-06441-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We sought to investigate the patient and physician approaches to malignant bowel obstruction (MBO) due to recurrent gynecologic cancer by (1) comparing patient and physician expectations and priorities during a new MBO diagnosis, and (2) highlighting factors that facilitate patient-doctor communication. METHODS Patients were interviewed about their experience during an admission for MBO, and physicians were interviewed about their general approach towards MBO. Interviews were analyzed for themes using QDAMiner qualitative analysis software. The analysis utilized the framework analysis and used both predetermined themes and those that emerged from the data. RESULTS We interviewed 14 patients admitted with MBO from recurrent gynecologic cancer and 15 gynecologic oncologists. We found differences between patients and physicians regarding plans for next chemotherapy treatments, foremost priorities, communication styles, and need for end-of-life discussions. Both patients and physicians felt that patient-physician communication was improved in situations of trust, understanding patient preferences, corroboration of information, and increased time spent with patients during and before the MBO. CONCLUSION Gaps in patient-physician communication could be targeted to improve the patient experience and physician counseling during a difficult diagnosis. Our findings emphasize a need for patient-physician discussions to focus on expectations for future cancer-directed treatments, support for patients at home with home health or hospice level support in line with their wishes, and acknowledgement of uncertainty while providing direct information about the MBO diagnosis.
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Affiliation(s)
- Claire Hoppenot
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA. .,Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Dan L Duncan Comprehensive Cancer Center, 7200 Cambridge St., Houston, TX, 77030, USA.
| | - Fay J Hlubocky
- Section of Hematologic Oncology, Program for Supportive Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Julie Chor
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
| | - S Diane Yamada
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
| | - Nita K Lee
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medical Center, Chicago, IL, USA
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