Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review

Area of Science:

• Oncology
• Gastroenterology
• Palliative Care

Background:

• Malignant bowel obstruction (MBO) management often involves parenteral nutrition (PN) and palliative venting gastrostomies (PVG).
• Limited data exist on the clinical and quality-of-life outcomes of PN and PVG in inoperable MBO.
• Informing clinical decision-making requires a better understanding of these interventions' impact.

Approach:

• A mixed-methods systematic review and narrative synthesis was conducted.
• Extensive database searches (MEDLINE, Embase, Cochrane, etc.) were performed up to April 2021.
• Included studies were independently screened and quality appraised.

Key Points:

• Forty-seven studies with 3538 participants were included in the review.
• PN and PVG appear to provide patients with valuable time at home and improve quality of life, despite burdens.
• PVG offers relief from nausea and vomiting; PN may maintain or improve nutritional and performance status.

Conclusions:

• Current evidence does not confirm survival benefits from PN or PVG for inoperable MBO.
• Patient and clinician beliefs support the use of these interventions for perceived benefits.
• Well-designed randomized controlled trials are needed to definitively assess survival outcomes, addressing concerns about equipoise.