Highlights
- •Survival after MBO diagnosis is 105 days.
- •MBO associated with uterine cancers have worse prognosis than those from ovarian cancers.
- •Surgery may mitigate differences between ovarian and uterine cancer patients with MBO.
- •Palliative care consultations are associated with fewer readmissions for MBO
- •Discussions at the time of MBO should include expected survival with different interventions for uterine vs ovarian cancer.
Abstract
Objectives
To describe and compare treatments and outcomes of patients with malignant bowel obstructions
(MBO) due to uterine or ovarian cancer.
Methods
Retrospective chart review from two institutions of women admitted 1/1/2005–12/31/2016
with a MBO from recurrent/progressive uterine or ovarian cancer. Data collected includes
patient characteristics, cancer-directed treatments before and after MBO, MBO management
strategies, and survival after MBO.
Results
Women with MBO from uterine cancer (n = 46) and ovarian cancer (n = 130) underwent
similar inpatient interventions such as inpatient chemotherapy and surgery. Median
overall survival (OS) after admission for MBO for all patients was 105 days and was
shorter for uterine cancer patients (57 vs 131 days, p = 0.0013). Uterine and ovarian
cancer patients who had surgery had similar survival (182 vs 210 days, p = 0.6), as
did those discharged on hospice from their first admission for MBO (26 vs 38 days,
p = 0.1). Uterine and ovarian cancer patients had similar rates of post-discharge
chemotherapy (37% vs 50%, p = 0.12), but uterine cancer patients who had chemotherapy
still had shorter survival (151 vs 225 days, p = 0.03).
Conclusions
MBO has a relatively poor prognosis. Ovarian and uterine cancer patients whose interventions
included surgery or hospice had similar outcomes. Among patients managed medically
without hospice, uterine cancer patients experienced worse survival, even when candidates
for subsequent chemotherapy. Patient counseling regarding goals of care at this difficult
juncture can be informed by these findings and will be enhanced by patient-reported
and qualitative data on the patient experience with MBO.
Keywords
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Article info
Publication history
Published online: May 02, 2019
Accepted:
April 27,
2019
Received in revised form:
April 24,
2019
Received:
March 27,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
