Patient-reported symptom burden associated with treatment modality for malignant bowel obstruction

Objective — To compare patient-reported outcomes after hospitalization for malignant bowel obstruction (MBO) treated with surgical, procedural, or medical intervention.

Background — The optimal palliative treatment for MBO is unclear due to the paucity of research examining patient-reported outcomes, including symptom relief, after MBO treatment.

Methods — We performed a population-level analysis of individuals with incurable gastric, pancreatic, and colorectal cancer and hospitalized with a MBO from 2010-2019 with prospectively collected Edmonton Symptom Assessment System (ESAS) scores in Ontario, Canada. Mixed linear models were used to compare scores by treatment from -1-6 months from MBO admission.

Results — Of 1,749 MBO patients, 55.3% underwent surgery, 38.5% underwent medical care, and 6.2% underwent a procedure. Moderate-to-severe symptom scores (≥4) were highest for tiredness, lack of well-being, and lack of appetite the month prior to (46.6%, 45.8%, & 42.9%) and after MBO (53.4%, 51.9%, & 42.9%). There was a ≥10% decrease in percentage of patients reporting moderate-to-severe ESAS scores for pain, tiredness, and lack of appetite and well-being over the 6-month period. Except for lack of appetite and pain, there were no differences in scores over time based on treatment (P>0.05). Those who underwent surgery reported a greater decrease in symptom scores for lack of appetite and pain over time compared to those who underwent medical care (P≤0.05).

Conclusions — Patients hospitalized with MBO reported improvements in symptoms over time, with surgical patients reporting slightly greater symptom relief over time for appetite and pain. These data suggest a potential palliative benefit associated with surgery in select patients.