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Poster Number 142 – 184 – Pain & symptom management: Poster No: 158
The management of malignant ascites in Palliative care: An audit of clinical practice and development of standards and guidelines
  1. Leslie Johney1,
  2. Laura Chapman2,
  3. Leslie Allsopp2,
  4. Marie Curie2,
  5. Dawn Gray3 and
  6. Anne Griffiths4
  1. 1Willowbrook Hospice, Liverpool, UK
  2. 2Palliative Care Institute, Liverpool, UK
  3. 3Liverpool Womens Institute, Liverpool, UK
  4. 4Clatterbridge Centre of Oncology, Liverpool, UK

Abstract

Background Malignancy is the underlying cause in approximately 10% of all cases of ascites. About 15–50% of patients with malignancy will develop ascites. Cancers commonly associated with the development of ascites include breast, colorectal, endometrial, gastric, ovarian and pancreatic cancer. Several pathophysiological mechanisms are implicated in the development of malignant ascites. Management should be aimed at maximising patient comfort and quality of life. Management options include diuretic therapy, therapeutic paracentesis and peritoneovenous shunts. Oncological interventions maybe helpful for patients with ovarian malignancy and lymphoma. Hormonal treatments maybe useful for management of receptor positive cancers like breast cancer.

Aims A supra regional re-audit of palliative care network practice was performed which established compliance with regional guidelines. Two questionnaires were developed. The first questionnaire gathered information on individual anonymised patients with ascites. The second questionnaire focused predominantly on clinical practice when carrying out paracentesis.

Methods A prospective case-note audit of patients with ascites within specialist palliative care services in the network. Data were collected over 6 months from hospice, community, hospital advisory palliative care teams. Collected data included management of ascites with drugs, paracentesis and the use of permanent indwelling catheters for the management.

Results More than 50% of patients had an Ultrasound prior to drainage of ascites. 30% of patients had paracentesis at the Hospice. Only 40% of staff had access to units where permanent indwelling catheters was being inserted. Most units did not have a scanning device in house.

Conclusion Examination of current practise in the Merseyside and Cheshire Cancer Network shows that management of ascites is predominantly using diuretics and paracentesis as per previous standards and guidelines. However there are units who now insert permanent indwelling catheters. Some units also have their own ultrasound device for diagnosing ascites and marking out the site of needle insertion.

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