Clinical and Nutritional Care Pathways of Patients with Malignant Bowel Obstruction: A Retrospective Analysis in a Tertiary UK Center

Abstract

We describe a retrospective cohort study of patients with malignant bowel obstruction to examine their nutritional care pathways between 1.1.16 and 31.12.16 with readmissions until 31.12.17. Data were analyzed by comparing patients who were referred (R) and not referred (NR) for PN. We identified 72 patients with 117 MBO admissions (mean ± SD age:63.1 ± 13.1yrs, 79% female). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and lower-gastrointestinal cancers (76%). 83% patients had metastases (61% sub-diaphragmatically). All patients were at high-risk of malnutrition and baseline mean weight loss was 7%. Discussion of PN at multidisciplinary team meeting (MDT) (22% vs.5%, P = 0.02) and dietetic contact (94% vs. 41%, P < 0.0001) were more likely to occur in the R group. In 13/69 MBO admissions in NR group, reasons for non-referral were unclear. Median baseline and follow-up weight was similar (55-55.8 kg). Overall survival was 4.7 (1.4-15.2)months, with no differences by referral groups. We compared a sub-sample of patients who 'may have' required PN (n = 10) vs. those discharged on home PN (n = 10) and found greater survival in the HPN group (323vs.91 day, P < 0.01). Our findings highlight disparity in care pathways suggesting that nutritional care should be integrated into clinical management discussion(s) at MDT to ensure equal access to nutritional services.

Nutritional Status and Quality of Life in Hospitalised Cancer Patients Who Develop Intestinal Failure and Require Parenteral Nutrition: An Observational Study

“…However, the majority of studies have been performed in home settings [20], not taking into account the adverse effects of prolonged hospitalisation or acute health conditions. Thus, although it has been suggested that oncology patients with short-term inpatient PN provision might report improved QoL [20], this improvement may be in part due to the benefits of the multimodal therapy that they receive during hospitalisation [21].…”

Inoperable malignant bowel obstruction: palliative interventions outcomes – mixed-methods systematic review

“…Online supplemental file 4 provides summary descriptions of the included quantitative studies. There were 6 prospective,27–32 35 retrospective cohort studies,7 8 33–67 1 mixed-method study68 and 2 RCTs 69 70. Sample sizes ranged from 7 to 629.…”

“…Sample sizes ranged from 7 to 629. Studies were globally represented; 1 study from Australasia,50 5 from Asia,31 40 60 69 70 17 from Europe27–30 32 35 39 42 44–47 54 64 67 68 and 21 from North America 7 8 33 34 36–38 43 49 52 53 55–59 61–63 65 66…”

“…39 Only two retrospective cohort studies compared survival in those receiving PN compared with those who did not as a sole intervention. Those receiving PN lived longer (323 vs 91 days, p=0.0021 45 ; 72 vs 41 days, p=0.01. 36 Though for one study 45 this improved survival compared those who received PN to those who did not despite being assessed retrospectively as eligible by the study team.…”

MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

“…MBO symptoms usually start gradually and become more frequent and severe when a complete obstruction occurs. Re-obstruction and malnutrition are common, with malnutrition being an independent predictor of poor survival in this population [5][6][7][8].…”