Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double- blind, controlled clinical trial.
BACKGROUND
Conservative treatment of inoperable bowel obstruction in terminal cancer patients has been found to be effective in controlling the distressing symptoms caused by this complication. The purpose of this study was to evaluate the efficacy of octreotide in the management of nausea, vomiting and abdominal pain, secondary to bowel obstruction in terminally ill cancerpatients, when surgery was inappropriate.


METHODS
Sixty-eight terminally ill cancer patients participated in the study (age range 42-77 years, 36 male, 32 female). The primary cancer location was in the gastrointestinal system, the abdomen and the pelvis. The survival time ranged from 7 to 61 days. Diagnosis was made on clinical grounds and confirmed by plain abdominal radiography. The patients were randomly assigned into two equal groups, A (N=34) and B (N=34). Group A received, by continuous subcutaneous (c.sc.) administration with a pump: hyoscine butylbromide 60-80mg/day and chlorpromazine (15-25 mg/day); group B received octreotide 600-800 microg/day and chlorpromazine (15-25 mg/day). As an opioid, patients received either a low-dose of morphine (1,530mg/day) in continuous subcutaneous administration or TTS Fentanyl (25-75 microg/hour). Diary cards were used to monitor vomiting. nausea, pain intensity, anorexia and fatigue. The symptoms were assessed at T1-baseline, T2 and T3-third and sixth day of treatment, respectively, and T4- one day before death.


RESULTS
Data analysis showed there were statistically significant differences between the two groups: a) in vomiting and nausea in relation to percentage change from T1 to T2 and b) in fatigue and anorexia in relation to symptom improvement at T1 to T2, T1 to T3 and T1 to T4 (p<0.05), while in pain there was no statistically significant difference between the two groups in relation to percentage change from T1 to T2, T1 to T3 and T1 to T4.


CONCLUSIONS
The administration of octreotide, in combination with traditional pharmacological treatment, can be very effective in the symptom management of inoperable bowel obstruction in terminal cancerpatients
Mystakidou
Kyriaki
K
Microbiology Department, Areteion Hospital, University of Athens, Greece.
Tsilika
Eleni
E
Kalaidopoulou
Ourania
O
Chondros
Kostas
K
Georgaki
Stavroula
S
Papadimitriou
Lila
L
D000008:Abdominal Neoplasms / Q000150:complications; D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use; D002086:Butylscopolammonium Bromide / Q000627:therapeutic use; D002746:Chlorpromazine / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005770:Gastrointestinal Neoplasms / Q000150:complications; D006801:Humans; D007279:Injections, Subcutaneous; D007415:Intestinal Obstruction / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000209:etiology; D009369:Neoplasms / Q000150:complications*; D015282:Octreotide / Q000627:therapeutic use*; D010166:Palliative Care; D010386:Pelvic Neoplasms / Q000150:complications; D014839:Vomiting / Q000188:drug therapy / Q000209:etiology
D000932:Antiemetics; D005765:Gastrointestinal Agents; D002086:Butylscopolammonium Bromide; D015282:Octreotide; D002746:Chlorpromazine