Optimizing the Care of Malignant Bowel Obstruction in Patients With Advanced Gynecologic Cancer
| Autor: | Johane P. Allard, Yeh Chen Lee, Sunu Cyriac, Eran Shlomovitz, Sarah Buchanan, Catherine A. O’Brien, Tanya P. Chawla, Lisa Tinker, Jenny Lau, Terri Stuart-McEwan, Nazlin Jivraj, Jennifer Croke, Kashish Nathwani, Pamela Ng, Katherine Karakasis, Valerie Bowering, Amit M. Oza, Sarah E. Ferguson, Lisa Wang, Neesha C. Dhani, Stephanie Lheureux |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Canada medicine.medical_specialty Genital Neoplasms Female MEDLINE ORIGINAL CONTRIBUTIONS 03 medical and health sciences 0302 clinical medicine Gynecologic cancer medicine Humans Intestinal obstruction surgery In patient Focus on Quality 030212 general & internal medicine Aged Neoplasm Staging Aged 80 and over Ovarian Neoplasms Oncology (nursing) business.industry Health Policy General surgery Palliative Care Middle Aged medicine.disease Hospitalization Bowel obstruction Oncology 030220 oncology & carcinogenesis Genital neoplasm Female Neoplasm staging Complication business Intestinal Obstruction |
| Zdroj: | Journal of Oncology Practice |
| ISSN: | 1935-469X 1554-7477 |
| DOI: | 10.1200/jop.18.00793 |
| Popis: | PURPOSE: Malignant bowel obstruction (MBO) is a common and distressing complication in women with advanced gynecologic cancer. A pilot, interprofessional MBO program was launched in 2016 at a large Canadian tertiary cancer center to integrate these patients’ complex care needs across multiple disciplines and support women with MBO. METHOD: Retrospective analysis to evaluate the outcomes of women with advanced gynecologic cancer who were admitted to hospital because of MBO, before (2014 to 2016: baseline group) and after (2016 to 2018) implementation of the MBO program. RESULTS: Of the 169 women evaluated, 106 and 63 were in the baseline group and MBO program group, respectively. Most had ovarian cancer (n = 124; 73%) and had small-bowel obstruction (n = 131; 78%). There was a significantly shorter cumulative hospital length of stay (LOSsum) within the first 60 days of MBO diagnosis in the MBO program group compared with the baseline group (13 v 22 days, respectively; adjusted P = .006). The median overall survival for women treated in the MBO program was also significantly longer compared with the baseline group (243 v 99 days, respectively; adjusted P = .002). Using the interprofessional MBO care platform, a greater proportion of patients received palliative chemotherapy (83% v 56%) and less surgery (11% v 21%) in the MBO program group than in the baseline group, respectively. A subgroup of women (n = 11) received total parenteral nutrition for longer than 6 months. CONCLUSION: Implementation of a comprehensive, interprofessional MBO program significantly affects patient care and may improve outcomes. Unique to this MBO program is an integrated outpatient model of care and education that empowers patients to recognize MBO symptoms for early intervention. |
| Databáze: | OpenAIRE |
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