scholarly journals Illness Understanding, Prognostic Awareness, and End-of-Life Care in Patients With GI Cancer and Malignant Bowel Obstruction With Drainage Percutaneous Endoscopic Gastrostomy

2020 ◽  
pp. OP.20.00035
Author(s):  
Jessica I. Goldberg ◽  
Debra A. Goldman ◽  
Sarah McCaskey ◽  
Douglas J. Koo ◽  
Andrew S. Epstein
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Malignant Bowel Obstruction ◽  
Do Not Resuscitate ◽  
Future Expectations ◽  
Endoscopic Gastrostomy ◽  
Gi Cancer ◽  
Additional Chemotherapy

PURPOSE: Malignant bowel obstruction (MBO) is common in advanced GI cancer, and MBO management, including drainage percutaneous endoscopic gastrostomy (dPEG), is palliative. How patients understand the goals of dPEG and its impact on disease is inadequately understood in the literature. Therefore, we analyzed these issues in patients with GI cancer. METHODS: Demographics, clinical variables, and patient outcomes were abstracted from the medical record. Illness understanding and future expectations were retrieved from palliative care notes. We described additional treatment and outcomes after dPEG and estimated overall survival (OS). RESULTS: From January 2015 to June 2017, 125 admitted patients with metastatic GI cancer underwent dPEG for MBO. Cancers were most commonly colorectal (34%) and pancreatic/ampullary (25%). During the dPEG admission, 32% (40 of 125) of patients had a palliative care consultation, and 22% (28 of 125) were asked about illness understanding and future expectations. All (28 of 28) reported good understanding of the advanced nature of their disease, but few were accurate about prognosis given their stage IV disease (10 of 28). Of the 117 (94%) discharged, 13% (15 of 117) received additional chemotherapy, which rarely prevented progression; half (63 of 117) had a do-not-resuscitate order; and most (101 of 117) were enrolled in hospice at death. Median time to death was 37 days (95% CI, 29 to 45 days); 6-month OS was 3.7% (95% CI, 1.2% to 8.4%). CONCLUSION: dPEGs are placed close to end of life in patients with advanced GI cancer. A minority of patients receive additional chemotherapy post-dPEG. Many have adequate disease understanding, but chemotherapy benefit is low, and future expectations vary. This may be an opportunity for improved communication regarding palliative procedures in advanced cancer.

Therapy-related issues: palliative care

2017 ◽  
Author(s):  
Philip Wiffen ◽  
Marc Mitchell ◽  
Melanie Snelling ◽  
Nicola Stoner
Keyword(s):  
Spinal Cord ◽  
Palliative Care ◽  
End Of Life ◽  
Bowel Obstruction ◽  
End Of Life Care ◽  
Cord Compression ◽  
Life Care ◽  
Malignant Bowel Obstruction ◽  
Mouth Care ◽  
Dying Patient

This chapter covers important information for the pharmacist relating to palliative care. Conditions commonly seen when caring for patients at the end of life are covered, including anorexia, fatigue, and anaemia. Other topics include hypercalcaemia of malignancy, mouth care, noisy breathing, insomnia, spinal cord compression, and malignant bowel obstruction. In addition, this chapter includes detail on the priorities for end-of-life care, relating these to prescribing in the dying patient.

Percutaneous endoscopic gastrostomy for decompression of malignant bowel obstruction

2013 ◽  
Vol 26 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Noboru Kawata ◽  
Naomi Kakushima ◽  
Masaki Tanaka ◽  
Hiroaki Sawai ◽  
Kenichiro Imai ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Malignant Bowel Obstruction ◽  
Endoscopic Gastrostomy

Who Goes Home after Palliation? Utilization of Venting Percutaneous Endoscopic Gastrostomy in Malignant Bowel Obstruction

2016 ◽  
Vol 223 (4) ◽  
pp. S49-S50
Author(s):  
Christy E. Cauley ◽  
Elizabeth J. Lilley ◽  
Joel Weissman ◽  
Angela M. Bader ◽  
David L. Hepner ◽  
...  
Keyword(s):  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Malignant Bowel Obstruction ◽  
Endoscopic Gastrostomy

Malignant Bowel Obstruction

2011 ◽  
Vol 28 (8) ◽  
pp. 576-582 ◽  
Author(s):  
Elisabeth A. Dolan
Keyword(s):  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Surgical Procedures ◽  
Symptom Management ◽  
Performance Status ◽  
Malignant Bowel Obstruction ◽  
Medical Interventions ◽  
Less Invasive ◽  
Endoscopic Gastrostomy ◽  
Pelvic Malignancies

Malignant bowel obstruction is common in individuals with intra-abdominal and pelvic malignancies and results in considerable suffering. Treatments target both the resolution of obstruction and symptom management. Emerging procedures include stents placement in the bowel to return patency and newer surgical procedures that are evolving to be less invasive. The use of medical interventions like corticosteroids, alone or in concert with additional drugs, can be utilized to achieve resolution of obstruction. Throughout treatment, it is important to also aggressively treat obstructive symptoms like pain and nausea/vomiting. This can mostly be achieved with medications, but use of venting percutaneous endoscopic gastrostomy (PEG) can also relieve symptoms. Parenteral hydration and nutrition use remain controversial with this population. The factor most closely tied to prognosis is performance status.

scholarly journals Approach to Palliative Care Consultation for Patients With Malignant Bowel Obstruction in Gynecologic Oncology: A Qualitative Analysis of Physician Perspectives

2020 ◽  
Vol 16 (8) ◽  
pp. 483-489
Author(s):  
Claire Hoppenot ◽  
Fay J. Hlubocky ◽  
Julie Chor ◽  
S. Diane Yamada ◽  
Nita K. Lee
Keyword(s):  
Palliative Care ◽  
Qualitative Analysis ◽  
Bowel Obstruction ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Malignant Bowel Obstruction ◽  
Specific Patient ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Nonsurgical Patients

PURPOSE: Malignant bowel obstruction (MBO) from gynecologic cancer is associated with increased symptoms and short survival. A gynecologic oncologist’s approach to palliative care consultation in the setting of MBO has not been well studied—it could be an opportune time for collaboration with palliative care. MATERIALS AND METHODS: This qualitative analysis of interviews with gynecologic oncologists focuses on their perspectives on palliative care consultation at the time of MBO. Interviews were analyzed using a framework analysis, and key themes and quotations were extracted. RESULTS: We interviewed 15 gynecologic oncologists from 8 institutions in Chicago. They described a variety of expectations from palliative care consultation. Most frequently, they consulted palliative care for specific questions but managed the remainder of the care. Most participants frequently consulted palliative care, but they also worried about fragmentation of care, the timing of when to introduce a new team during MBO, and the selection of appropriate patients for a limited resource. Many participants preferred earlier palliative care consultation, and many described an emotional toll of caring for patients with MBO. Palliative care consultation was most readily discussed for nonsurgical patients. CONCLUSION: Participants’ expectations of palliative care consultations during MBO varied and were not always met. We recommend strengthening communication and protocols for palliative care involvement that meet the needs of specific patient populations and physician teams for surgical and nonsurgical patients. More research is needed to better understand how to integrate palliative care into oncologic and surgical care with gynecologic oncologists.

scholarly journals Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study

2020 ◽  
Vol 157 (3) ◽  
pp. 745-753
Author(s):  
Maria C. Cusimano ◽  
Katrina Sajewycz ◽  
Michelle Nelson ◽  
Nazlin Jivraj ◽  
Yeh Chen Lee ◽  
...  
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Bowel Obstruction ◽  
End Of Life Care ◽  
Self Management ◽  
Life Care ◽  
Malignant Bowel Obstruction
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