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Safety and effectiveness of interventions for malignant ascites with advanced cancer: Systematic review

Date

09 Oct 2016

Session

Poster display

Presenters

Diogo Martins-Branco

Citation

Annals of Oncology (2016) 27 (6): 455-461. 10.1093/annonc/mdw384

Authors

D. Martins-Branco, C. Ribeiro, B. Gomes

Author affiliations

  • King’s College, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London SE5 9PJ - London/GB
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Resources

Background

Malignant ascites (MA) - fluid within abdominal cavity due to intraperitoneal (IP) invasion by cancer cells - is a sign of advanced cancer and causes distressful symptoms such as abdominal pain and dyspnea. Aim: To determine the safety and effectiveness of interventions for MA in adults with advanced cancer.

Methods

We searched 5 electronic databases (April 2015), conducted citation searching and checked reference lists of included articles and 3 systematic reviews. We included randomised controlled trials and controlled clinical trials (RCTs / CCTs). 1 author screened titles/abstracts. Further screening, data extraction and quality assessment were independently conducted by 2 authors and a 3rd in cases of disagreement.

Results

We identified 5 studies (4 RCTs, 1 CCT), with 648 participants. When reported, age ranged between 23-92 years, 77% were women and most common primary cancers were ovarian (OC) (50%) and gastrointestinal (23%). 4 interventions were pharmacological: IP Cisplatin plus Bevacizumab did not cause adverse effects (AE) and enhanced quality of life (QoL) in MA of OC, compared to IP Cisplatin alone (1 RCT, n = 58); IP Catumaxomab when added to paracentesis induced more AE (abdominal pain, pyrexia, vomiting/nausea), despite reduction in MA-related symptoms (1 RCT, n = 258); IP Catumaxomab-induced AE failed to be prevented by Intravenous Prednisolone (1 RCT, n = 219); Intramuscular Long-acting (LA)-Octreotide did not increase AE, but had limited QoL benefit compared to placebo (1 RCT, n = 33). 1 non-pharmacological intervention, abdominal massage, was safe and reduced abdominal bloating, depression and anxiety, compared to social interaction (1 CCT, n = 58).

Conclusions

Cisplatin plus Bevacizumab appears safe and effective for the management of MA in OC, Catumaxomab added to parencentesis increased AE, LA-Octreotide appears safe but with limited effectiveness, and abdominal massage is promising. However, these findings need to be confirmed in more trials.

Clinical trial identification

N/A

Legal entity responsible for the study

Systematic review for MSc in Palliative Care at KCL

Funding

Systematic review for MSc in Palliative Care at KCL

Disclosure

All authors have declared no conflicts of interest.

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