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Malignant bowel obstruction in advanced ovarian cancer: A retrospective analysis of patients supported with parenteral nutrition
Wight, Rebecca Murphy, A. D. Bower, J. Morgan, Robert David Flanagan, L. Maycock, S. Lal, S. Teubner, A. Abraham, A. Mitchell, Claire L
Wight, Rebecca
Murphy, A. D.
Bower, J.
Morgan, Robert David
Flanagan, L.
Maycock, S.
Lal, S.
Teubner, A.
Abraham, A.
Mitchell, Claire L
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Abstract
Background: Malignant bowel obstruction (MBO) is common in advanced ovarian
cancer (AOC). Treatment options are limited as majority of cases present with
widespread, multilevel peritoneal dissemination and platinum-resistant disease. The
benefit of Parenteral Nutrition (PN) in MBO is debated, given the limited overall
survival (OS) of this patient group. Aim: to identify which clinical features correlate
with improved survival in AOC and MBO, to support clinical decision-making.
Methods: Retrospective review of patients admitted with MBO between April 2019
and October 2021 to a single tertiary cancer centre. Those with AOC established on
PN with the aim to discharge home on PN were included. Univariate analysis for
survival after commencing PN was performed using log-rank test.
Results: 103 patients with MBO were identified with 33 patients excluded (PN not
initiated, 15; PN withdrawn: covid service constraint, 5, acute medical event, 13). 70
patients were successfully established on PN and 49 discharged on PN; 16 patients
clinically deteriorated; 5 returned to enteral diet. Median OS of patients that did not
receive PN was 19 days, PN stopped due to general deterioration 39 days and 100
days (range 18-807) for those established on PN (p<0.0001). Clinical features asso ciated with improved OS: no prior systemic therapy (p¼0.0067), platinum sensitivity
(p¼0.043), ECOG performance status (PS) 1 vs 2-3 (p¼0.004), falling modified Glas gow Prognostic Score (mGPS) during admission (p¼0.0027). In the treatment naïve
group, chemotherapy resolved MBO in 6/9 cases. In the pre-treated group, 60% of
patients received subsequent chemotherapy (median duration 8 weeks), with early
cessation due to toxicity and no clinical benefit. Only 1 patient achieved resolution of
MBO on chemotherapy.
Conclusions: PN may improve survival of patients with AOC in MBO. ECOG PS,
platinum sensitivity and mGPS trend may be useful to select patients for PN. In those
presenting with MBO at AOC diagnosis, PN can enable safe delivery of chemotherapy,
which usually will resolve MBO. In pre-treated patients, PN is a life-long commitment and chemotherapy is largely ineffective in resolving MBO. Further research should
focus on quality of life in patients receiving PN.
Description
Date
2022
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Type
Meetings and Proceedings
Citation
Wight RKK, Murphy AD, Bower J, Morgan RD, Flanagan L, Maycock S, et al. Malignant bowel obstruction in advanced ovarian cancer: A retrospective analysis of patients supported with parenteral nutrition. Annals of Oncology. 2022 Jun;33:S400-S. PubMed PMID: WOS:000814982500044.