The range and suitability of outcome measures used in the assessment of palliative treatment for inoperable malignant bowel obstruction: A systematic review

Abstract

Background: Malignant bowel obstruction, a complication of certain advanced cancers, causes severe symptoms which profoundly affect quality of life. Clinical management remains complex, and outcome assessment is inconsistent. Aim: To identify outcomes evaluating palliative treatment for inoperable malignant bowel obstruction, as part of a four-phase study developing a core outcome set. Design: The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); PROSPERO (ID: CRD42019150648). Eligible studies included at least one subgroup with obstruction below the ligament of Treitz undergoing palliative treatment for inoperable malignant bowel obstruction. Study quality was not assessed because the review does not evaluate efficacy. Data sources: Medline, Embase, the Cochrane Database, CINAHL, PSYCinfo Caresearch, Open Grey and BASE were searched for trials and observational studies in October 2021. Results: A total of 4769 studies were screened, 290 full texts retrieved and 80 (13,898 participants) included in a narrative synthesis; 343 outcomes were extracted verbatim and pooled into 90 unique terms across six domains: physiological, nutrition, life impact, resource use, mortality and survival. Prevalent outcomes included adverse events (78% of studies), survival (54%), symptom control (39%) and mortality (31%). Key individual symptoms assessed were vomiting (41% of studies), nausea (34%) and pain (33%); 19% of studies assessed quality of life. Conclusions: Assessment focuses on survival, complications and overall symptom control. There is a need for definitions of treatment ‘success’ that are meaningful to patients, a more consistent approach to symptom assessment, and greater consideration of how to measure wellbeing in this population.

Difficulties and Disparities in Colorectal Cancer End-of-Life Care: A Patient's Story

“…Reproduced from Bravington et al 2023. 33 Within the broad categories of surgical, procedural, and medical treatment options, there are a variety of pathways that have remained fairly stable over time. [31][32][33][34] Surgeries can involve resection, bypass, and ostomy formation.…”

“…33 Within the broad categories of surgical, procedural, and medical treatment options, there are a variety of pathways that have remained fairly stable over time. [31][32][33][34] Surgeries can involve resection, bypass, and ostomy formation. Procedural interventions include stents and percutaneous endoscopic gastrostomy tube placement for decompression.…”

“…29 30 Until recently, efforts to understand the role of these different treatment alternatives has been stymied by the absence of high-quality data. 31 32 Specific limitations include the lack of consistent definitions, even of the condition itself. 31 32 There has been a consensus that the outcomes measured in most studies including survival and hospital discharge are not the most meaningful to patients and families.…”

“…31 32 Specific limitations include the lack of consistent definitions, even of the condition itself. 31 32 There has been a consensus that the outcomes measured in most studies including survival and hospital discharge are not the most meaningful to patients and families. The nature of the condition creates challenges to prospective studies and randomized trials that compare different alternatives.…”

Exploring pathways to optimise care in malignant bowel obstruction (EPOC): Protocol for a three-phase critical realist approach to theory-led intervention development for shared decision-making

“…While some local NHS Trusts have produced guidelines for management of the condition, these emerge from clinical experience rather than a broad evidence-base including patient perspectives. There are variations in clinical practice between units, and attention to quality of life is lacking [ 5 ].…”