Impact of treatment strategy after malignant bowel obstruction in stage IV gastrointestinal cancer: population-based cohort study

Background — Malignant bowel obstruction in patients with stage IV gastrointestinal cancer represents a challenging scenario, with a lack of patient-centred outcome data to guide decisions. This study evaluated the association between days at home, and malignant bowel obstruction palliation treatment strategy in this subgroup of patients.

Methods — This population-based retrospective cohort study included adults with stage IV gastrointestinal cancer admitted for malignant bowel obstruction between 2010 and 2019. Patients with stage IV gastrointestinal cancer treated with curative intent were excluded. The primary exposure was treatment strategy at first admission with malignant bowel obstruction divided into surgical, procedural (percutaneous or endoscopic), and supportive care. The primary outcome of interest was days at home over 90 days. Multivariable quantile regression was used to evaluate the association between treatment strategy and days at home over 90 days adjusted for cancer and patient factors. Quantile plots were used to examine this association across the distribution of days at home over 90 days.

Results — Of 12 923 patients admitted, 4642 were selected: 2076 (44.7%) received surgical, 310 (6.7%) procedural, and 2256 (48.6%) supportive care. Those who had surgical treatment had the highest median days at home over 90 days of 67 (interquartile range 23–80) days, followed 45 (7–78) days with procedural treatment, and 31 (0–76) days with supportive care. After adjusting for patient and cancer factors, surgical treatment was associated with an increase in median days at home over 90 days of 20 (95% confidence interval 15–24) days and procedural treatment with an increase of 14 (6–22) days. The directionality of these findings was stable across the distribution of days at home over 90 days, and stable in sensitivity analysis after exclusion of deaths.

Conclusion — Surgical and procedural treatment were associated with increased days at home over 90 days. These findings can support decision-making and expectation setting in patients eligible for surgical and procedural treatments.