MANAGEMENT OF MALIGNANT BOWEL OBSTRUCTION IN PATIENTS WITH ADVANCED CANCER AT THE END OF LIFE

Abstract

Background. Malignant bowel obstruction in patients with advanced cancer at the end of life is common. Patients may have substantial symptoms (pain, nausea and vomiting) and experience aggressive care at the end of life. Due to lack of robust evidence, the care algorithm of treatment is not standardized. Patient’s prognosis, clinical condition and preferences related to goals of care discussion must be considered when opting between comfort focused care, palliative procedures and surgery.

Methods. A systematic literature search was conducted in PubMed/Medline to identify recommendation on the management of malignant bowel obstruction in patients with advanced cancer at the end of life. The search focused on symptom management using MeSH terms related to intestinal obstruction in patients with advanced cancer at the end of life.

Results. Using the MeSH terms related search in PubMed/Medline, 3,532 articles were initially identified. After applying filters, 535 articles were selected for further review. Additional sources included reference lists and grey literature. In total, 85 references were used to support the management recommendations in this article.

Conclusions. It is essential to engage patients and families in goals of care discussions to promote understanding of the palliative intent of different malignant bowel obstruction interventions. Research is needed to assist clinicians in decision making to provide patients with appropriate care. Criteria for the selection of candidates for palliative surgery are needed to avoid significant complications and overly aggressive treatment at the end of life when the focus is maintaining and enhancing the quality of life of patients.