Patient-Reported Symptom Burden Associated with Treatment Modality for Malignant Bowel Obstruction

To compare patient-reported outcomes after hospitalization for malignant bowel obstruction (MBO) treated with surgical, procedural, or medical intervention.

The optimal palliative treatment for MBO is unclear due to the paucity of research examining patient-reported outcomes, including symptom relief, after MBO treatment.

We performed a population-level analysis of individuals with incurable gastric, pancreatic, and colorectal cancer and hospitalized with a MBO from 2010-2019 with prospectively collected Edmonton Symptom Assessment System (ESAS) scores in Ontario, Canada. Mixed linear models were used to compare scores by treatment from -1-6 months from MBO admission.

Of 1,749 MBO patients, 55.3% underwent surgery, 38.5% underwent medical care, and 6.2% underwent a procedure. Moderate-to-severe symptom scores (≥4) were highest for tiredness, lack of well-being, and lack of appetite the month prior to (46.6%, 45.8%, & 42.9%) and after MBO (53.4%, 51.9%, & 42.9%). There was a ≥10% decrease in percentage of patients reporting moderate-to-severe ESAS scores for pain, tiredness, and lack of appetite and well-being over the 6-month period. Except for lack of appetite and pain, there were no differences in scores over time based on treatment (P>0.05). Those who underwent surgery reported a greater decrease in symptom scores for lack of appetite and pain over time compared to those who underwent medical care (P≤0.05).

Patients hospitalized with MBO reported improvements in symptoms over time, with surgical patients reporting slightly greater symptom relief over time for appetite and pain. These data suggest a potential palliative benefit associated with surgery in select patients.