Treatment Patterns, Outcomes, and Costs for Bowel Obstruction in Ovarian Cancer

Abstract

Objective To assess treatment patterns, outcomes, and costs for bowel obstruction in ovarian cancer. Methods/materials All patients with stage II–IV ovarian cancer who were admitted for bowel obstruction ≥6 months after cancer diagnosis from 2000–2011 were identified from the Surveillance, Epidemiology, and End Results registry (SEER)–Medicare database. Management strategies and outcomes of bowel obstruction were compared. Results Among 1,397 women with bowel obstruction, 562 (40%) underwent surgery and 154 (11%) had a gastrostomy or jejunostomy (G/J) tube placed. 34% of patients who underwent surgery subsequently received chemotherapy, compared to 8% of those managed with a G/J tube (OR 4.8, 95% CI 2.7-8.8). 30-day complications were higher for patients in the surgery group compared to the tube group (69% vs 46%, OR 2.5, 95% CI 1.8-3.7), as were mean adjusted 30-day total costs ($28,872 vs $18,528, p<.001). Median survival was greater for women who underwent surgery compared to those who had a G/J tube (5.3 vs 1.2 months; adjusted HR 0.31, 95%CI 0.25-0.38). The median survival of patients in whom surgical correction failed and required G/J tube placement during the same inpatient admission was 2.6 months. Women who received post-intervention chemotherapy had improved survival compared to those who did not in both the surgery (17.0 vs 2.8 months, p<.001) and G/J tube groups (5.7 vs 1.0 months, p<.001). Conclusions In women with ovarian cancer who develop bowel obstruction, surgery may benefit a subset of patients, likely related to the ability to receive subsequent chemotherapy. Efforts to identify those who derive no benefit may reduce unnecessary laparotomy, along with its associated complications and costs. Given this population’s limited survival, patient preferences should be evaluated in future studies assessing the management of bowel obstruction.

Epithelial ovarian cancer

“…MBO management is not well defined and includes potential surgical or radiology intervention, medical support and the ethical dilemma of total parenteral nutrition (TPN). Efforts are on-going to offer a multidisciplinary management including surgery, chemotherapy, radiation, interventional radiology and include patients' preferences 138,139 . In this setting, the question of TPN remains difficult as the selection of patients who will benefit from TPN is not well described and the majority of patients will die from cancer process, not starvation 140 .…”

Palliative treatment of intestinal obstruction in patients with gynecologic malignancies — single center experience

“…Intestinal obstruction is one of the most common symptoms affecting even every second patient with advanced gynecologic tumors located in the pelvis [6]. Reported incidence of this complication among ovarian cancer patients varies between 20 and 50% [7,8].…”

Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer

“…Few studies have proven that patients with MBO appear to benefit from surgical interventions compared to patients who received medical treatment, showing that the surgical group had longer median survival, shorter hospitalization, pain reduction, higher number of chemotherapy lines, and lower reobstruction rate. 4,20–22 However, some of these reports 20,21 analyzed the treatment outcome in highly selected patients with specific clinical characteristics, including good performance status, absence/small volume ascites, and single-site disease. On the other hand, in a recent Cochrane review, no definitive recommendations were made on the role of surgery in MBO secondary to gynecologic and gastrointestinal tumors.…”