Bowel obstruction in home-care cancer patients: 4 years experience.
Conservative management of bowel obstruction in advanced cancer patients has been recognized as efficacious in controlling distressing symptoms such as nausea, vomiting and pain. A retrospective analysis of prevalence, treatment and outcome was performed. A group of 25 patients with signs of bowel obstruction were studied from 1001 consecutive patients receiving palliative care at home. A score for total distress was calculated to assess the gastrointestinal symptoms at diagnosis, after 1 week of treatment and 1 day before death. The mean survival was 19 days. Six patients were admitted to hospital, 3 of whom underwent surgery and died in the immediate postoperative period. The patients diagnosed in hospital and discharged received a nasogastric tube (7 cases) and a central venous line. The nasogastric tube was removed after gastrointestinal secretions had been controlled by a combination of drugs, and parenteral nutrition or hydration, mainly started in hospital, was discontinued only a few days before death (13 cases, mean duration 19 days). The distress symptom score was statistically reduced after 1 week of treatment and on the day before death when compared to the referral time. The most frequent combination of drugs was octreotide, haloperidol and low doses of morphine. A subcutaneous route was preferred for administering the drugs. Utilization of a wide range of drugs permits good symptom control for bowel obstruction in patients followed at home.
Mercadante
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Department of Anesthesia and Intensive Care, Buccheri La Ferla Fatebenefratelli Hospital, SAMOT, Palermo, Italy.
D000008:Abdominal Neoplasms / Q000150:complications*; D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006220:Haloperidol / Q000627:therapeutic use; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy*; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use; D010166:Palliative Care; D010288:Parenteral Nutrition; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D009020:Morphine; D006220:Haloperidol; D015282:Octreotide