title: Palliative care in patients with ovarian cancer and bowel obstruction.
abstract: OBJECTIVE
  Malignant bowel obstruction (MBO) is usually a pre-terminal event in patients with ovarian cancer. However, because of the lack of data in literature, decisions around surgical intervention, non-resectional procedures, or medical treatment of MBO in patients with ovarian cancer cannot be lightly undertaken. We analyzed medical and surgical procedures, performance status, nutritional status, cachexia, and their prognostic value in this group of patients.
  
  
  METHODS
  We retrospectively selected all consecutive patients with recurrent ovarian cancer who received medical or surgical treatment for MBO between October 2008 and January 2014 at the Academic Department of Gynecological Oncology of Mauriziano Hospital of Turin (Italy).
  
  
  RESULTS
  We found 40 patients: 18 of them underwent medical treatment and 22 of them were submitted to surgery. In the group of surgery, the hospitalization was shorter (p 0.02), the pain reduction was more effective (p 0.001), the number of chemotherapy lines was higher (p 0.03), and re-obstruction was more rare (p 0.02). Between the two groups, we did not find any differences in post-palliation episodes of vomit (p 0.83), type of diet (p 0.34), ability to return home (p 0.72), and death setting (p 0.28). Median survival after palliation was longer in the group of surgery (p 0.025). Cachexia, low performance status, and poor nutritional status were significant predictors of worse survival after MBO, independently by the treatment.
  
  
  CONCLUSIONS
  Surgery has to be considered in patients without serious contraindications; otherwise, a medical protocol, including antisecretory drugs, is the standard of care in frail patients.
authors: Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy. albertodaniele@hotmail.it.
authors: Alberto
authors: A
authors: Daniele
authors: Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: A
authors: A
authors: Ferrero
authors: Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: L
authors: L
authors: Fuso
authors: Department of Surgery, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: M
authors: M
authors: Mineccia
authors: Service of Palliative Care, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: V
authors: V
authors: Porcellana
authors: Service of Dietetics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: D
authors: D
authors: Vassallo
authors: Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: N
authors: N
authors: Biglia
authors: Academic Division of Gynecology and Obstetrics, Mauriziano Hospital, Via Magellano,1, 10128, Turin, Italy.
authors: G
authors: G
authors: Menato
mesh_terms: D000328:Adult; D000368:Aged; D002100:Cachexia / Q000188:drug therapy; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007558:Italy; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications* / Q000401:mortality; D010051:Ovarian Neoplasms / Q000150:complications* / Q000401:mortality; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Malignant bowel obstruction; Ovarian cancer; Palliative care