Background Malignant bowel obstruction (MBO) is a distressing complication of many advanced cancers, notably those of ovarian or colorectal origin. Most patients with advanced disease are managed medically to improve their symptoms, however variation exists in how this is achieved.
Aims The audit aimed to establish current practice in the management of MBO within a hospice inpatient unit, prior to writing evidence-based guidelines for use locally.
Methods Cases were identified by reviewing letters written for the last 100 patients who had died in the inpatient unit. Records were retrieved for patients with: MBO as certified cause of death; symptoms suggesting obstruction (nausea, vomiting, colic, abdominal distension, constipation); or cancers with a propensity to cause obstruction at any level. Case notes were reviewed and a database created to collate information including; primary diagnosis, presence of metastatic disease, likely cause of MBO, symptom response, pharmacological agents used and outcome of obstructive episode.
Results Fifty-one case records were consulted after screening. Twenty-three patients had clinical presentations suggestive of MBO. The majority (n=17) were female. Ages ranged from 50–89 years. Colorectal and gastric cancers were the commonest primaries. Eighteen patients received an antisecretory agent; nine were prescribed octreotide alone, two hyoscine butylbromide alone and seven a combination of both agents. Octreotide doses ranged from 200 mcg–1200 mcg/24 h. Indications for adding hyoscine butylbromide (20 mg 180 mg/24 h) were persisting large volume vomiting and the development of colic. Symptom improvement was recorded for all patients. The episode of obstruction resolved clinically in only two cases.
Conclusion This audit suggests that octreotide is the first line antisecretory agent in use within the Hospice. Hyoscine butylbromide was added for patients with on-going symptoms. Inclusion of hyoscine butylbromide as an additional antisecretory appeared of value in achieving symptom control, which the forthcoming guidelines will reflect.
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