MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

Abstract

Purpose To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. Methods The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions. Results The systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided. Conclusion This MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.

Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges

“…To alleviate symptoms like nausea and vomiting, patients admitted with acute MBO are put on a strict nil-by-mouth (NPO) and subjected to decompressive procedures. 29 , 30 Due to a lack of consensus and few published evidence, the management of the nutritional needs of patients presenting with advanced malignancies and MBO is controversial and ethically demanding. 30–32 …”

“…The Multinational Association of Supportive Care in Cancer (MASCC) recommends that patients are initially kept NPO and, with guidance from a dietitian, gradually transitioned in stages of oral diets if their MBO symptoms are resolving: from 1) clear fluids to, 2) full fluids to, 3) minced/pureed low fiber diet and then, 4) low fiber diet. 29 …”

“…A low residue/fiber diet assists to alleviate abdominal discomfort, such as bloating, pain, and nausea/vomiting. 23 , 29 , 33 , 34 It is recommended that patients and their caregivers receive nutrition instructions to help them adjust their diet in response to their symptoms. 32…”

“…Based on the goals of care, this may range from comfort feeding alone to TPN to maintain adequate calorie intake. 29 While deciding upon TPN, it is of prime importance to understand its role, cost, logistics and potential complications and also to discuss in detail goals of care and disease prognosis. 29 …”

“… 29 While deciding upon TPN, it is of prime importance to understand its role, cost, logistics and potential complications and also to discuss in detail goals of care and disease prognosis. 29 …”