CN105 - Malignant bowel obstruction in advanced cancer: A nurse-led review of symptom management, dietitian involvement and outcomes at two sites of an NHS Hospital Trust

Background

Malignant bowel obstruction (MBO) is a frequent complication in patients with advanced cancer. There are no national guidelines for the management of patients presenting with MBO. Clinical management relies on an individualised approach, based on prognosis and objectives of care. The priority of care for non-operable disease is symptom control and supportive management to either resume or start systemic anticancer therapy (SACT) if appropriate.

Methods

Data were collected via retrospective analysis of electronic patient records for patients referred to Chelsea and Westminster Hospitals AOS service from Jan 2023 to Dec 2023 with SBO. Eligible patients had newly diagnosed or known advanced solid cancers. The primary objective was to assess how many patients received systemic anticancer treatment after supportive management. Secondary objectives were to evaluate the timeliness of nutrition team input and if total parenteral nutrition (TPN) was started.

Results

There were 24 referrals to AOS with either bowel obstruction or gastric outlet obstruction. The median age was 60y (26-80) and 62.5% were females. 91.6% of patients had an existing diagnosis of cancer and all had metastatic disease. Most patients (87.5%) were managed conservatively, 40% received steroids and 12.5% received surgery or stenting. Only 36% received further SACT and only 50% of patient had a specialist palliative care team referral during their acute admission. More than 70% of all patients were referred to dieticians with median of 3 days (1-9) and 25% of patient received TPN. 28% of all patients did not receive SACT following this admission and 24% of all patients died during admission.

Conclusions

This study highlights the current variation in practice for patients presenting with MBO requiring supportive care. Decision making in this clinical scenario can be challenging and need to be tailored to individual patients who have a poor prognosis. All patients should have MDT discussion around nutrition, symptom control and care goals. No national guidelines exist and development of local and national guidance is warranted to improve symptoms and optimise patient care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.