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Management of Malignant Bowel Obstruction (MBO) in Patients with Advanced Gynecological Cancers
Guidelines for the management of patients with Malignant Bowel Obstruction(MBO) are not available and as such, there remains an urgent need for a collaborative approach to streamline patient care and optimize use of hospital resources. This study will focus on management of MBO in advanced gynecological cancers.If patients with MBO can be effectively managed in an ambulatory setting, this may improve quality and consistency of patient care, and help reduce volume and duration of bed occupancy.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Management algorithm for Malignant Bowel Obstruction | Other | a proposed management algorithm for MBO has been developed to provide a pathway that safeguards quality and continuity of care for patients under a multidisciplinary team. It will engage key-stakeholders and foster an inter-professional approach. It incorporates an in-patient management algorithm and a novel nursing-led ambulatory management algorithm to supplement patient's medical management |
| Measure | Description | Time Frame |
|---|---|---|
| Optimization of multidisciplinary care | To optimize the multidisciplinary care management of MBO in patients with advanced gynecological cancer treated at University Health Network (UHN) which include in-patient and ambulatory management algorithm for MBO • Measured by a ratio of days alive and out of hospital compare to days in hospital within the first 60 days after diagnosis of MBO | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluation of treatment outcomes | To evaluate the treatment outcomes of patients with MBO
| 2 years |
| Evaluation of impact of MBO management on hospital visits |
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Inclusion Criteria:
Histologically and /or cytologically confirmed gynecological cancer, including ovarian, fallopian tube, endometrial, cervical or primary peritoneal cancer Deemed to be at risk of developing or have a clinical diagnosis of MBO as defined using the following criteria: clinical evidence of bowel obstruction (history/physical/radiological examination; and bowel obstruction beyond the ligament of Treitz.
Exclusion Criteria:
There are no specified exclusion criteria for this study
Female
Patients with gynecological cancer and at risk or presently having Malignant bowel obstruction (MBO)
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| Name | Affiliation | Role |
|---|---|---|
| Stephanie Lheureux | University Health Network, Toronto | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Princess Margaret Cancer Centre | Toronto | Ontario | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25552305 | Background | Tran E, Spiceland C, Sandhu NP, Jatoi A. Malignant Bowel Obstruction in Patients With Recurrent Ovarian Cancer. Am J Hosp Palliat Care. 2016 Apr;33(3):272-5. doi: 10.1177/1049909114566225. Epub 2014 Dec 31. | |
| 23274561 | Background | Mooney SJ, Winner M, Hershman DL, Wright JD, Feingold DL, Allendorf JD, Neugut AI. Bowel obstruction in elderly ovarian cancer patients: a population-based study. Gynecol Oncol. 2013 Apr;129(1):107-12. doi: 10.1016/j.ygyno.2012.12.028. Epub 2012 Dec 26. |
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Patients with MBO who undergo palliative procedures or surgical intervention will be offered optional consent for tissue collection for research. Fresh-frozen and formalin-fixed paraffin-embedded (FFPE) tumour tissue specimens, as well as ascites will be collected for translational studies. Stool samples will be collected for microbiome analysis
To evaluate the impact of MBO management on number of emergency room visits, hospital admission and number of days alive and outside of hospital within the first 168 days (6 months) after the diagnosis of MBO |
| 2 years |
| Evaluation of impact of MBO management on patient reported outcomes | To evaluate the impact of ambulatory MBO management on patient reported outcomes using the Distress Assessment & Response Tool (DART) | 2 years |
| To evaluate nutritional status of patients with MBO | To evaluate the nutritional status of patients with MBO • Measured by monthly albumin and weight | 2 years |
| Evaluation of clinico-pathological factors | To evaluate the clinico-pathological factors that may predict benefit from palliative surgery, chemotherapy and total parenteral nutrition (TPN) | 2 years |
| Improve patient understanding and awareness of MBO | To improve patients' understanding and awareness of MBO with patient education material. | 2 years |
| Determine percentage number of patient microbiome sample analyses completed | To record the percentage of patients who agree to, and for whom sample collection and analysis is completed | 1.5 years |
| Record changes in the sum and types of gut microbiome from baseline to study end | Changes in the sum as well as types of microbiomes as recorded at baseline, initiation of total parenteral nutrition, incidence of an MBO and end of study are to be recorded | 1.5 years |
| Evaluate cannabis use in patient population | Assess for any relationship between cannabis use and MBO | 1.5 years |
| 19258942 | Background | Sartori E, Chiudinelli F, Pasinetti B, Maggino T. Bowel obstruction and survival in patients with advanced ovarian cancer: analysis of prognostic variables. Int J Gynecol Cancer. 2009 Jan;19(1):54-7. doi: 10.1111/IGC.0b013e318198ff4b. No abstract available. |
| 24767708 | Background | Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet. 2014 Oct 11;384(9951):1376-88. doi: 10.1016/S0140-6736(13)62146-7. Epub 2014 Apr 21. |
| Background | Martin-Lorente C, Mackay H, Lafromboise L, et al: Retrospective review of malignant bowel obstruction (MBO) outcomes in patients with epithelial ovarian carcinoma (EOC), International Journal of Gynecological Cancer, 2015, pp 1434-1435 |
| 17544243 | Background | Anthony T, Baron T, Mercadante S, Green S, Chi D, Cunningham J, Herbst A, Smart E, Krouse RS. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manage. 2007 Jul;34(1 Suppl):S49-59. doi: 10.1016/j.jpainsymman.2007.04.011. Epub 2007 Jun 4. |
| 11430417 | Background | Ripamonti C, Twycross R, Baines M, Bozzetti F, Capri S, De Conno F, Gemlo B, Hunt TM, Krebs HB, Mercadante S, Schaerer R, Wilkinson P; Working Group of the European Association for Palliative Care. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001 Jun;9(4):223-33. doi: 10.1007/s005200000198. |
| 22904637 | Background | Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012;4:159-69. doi: 10.2147/CMAR.S29297. Epub 2012 Jun 13. |
| 25805450 | Background | Daniele A, Ferrero A, Fuso L, Mineccia M, Porcellana V, Vassallo D, Biglia N, Menato G. Palliative care in patients with ovarian cancer and bowel obstruction. Support Care Cancer. 2015 Nov;23(11):3157-63. doi: 10.1007/s00520-015-2694-9. Epub 2015 Mar 25. |
| 18359221 | Background | Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008 May;44(8):1105-15. doi: 10.1016/j.ejca.2008.02.028. Epub 2008 Mar 21. |
| 26727399 | Background | Cousins SE, Tempest E, Feuer DJ. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2016 Jan 4;2016(1):CD002764. doi: 10.1002/14651858.CD002764.pub2. |
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| 22082991 | Background | Kolomainen DF, Daponte A, Barton DP, Pennert K, Ind TE, Bridges JE, Shepherd JH, Gore ME, Kaye SB, Riley J. Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol. 2012 Apr;125(1):31-6. doi: 10.1016/j.ygyno.2011.11.007. Epub 2011 Nov 12. |
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| 38821545 | Derived | Madariaga A, Jivraj N, Soberanis Pina P, Somji F, Truong T, Melwani S, Lovas M, Gogos TA, Sajewycz K, Bhat G, Alqaisi H, Gonzalez-Ochoa E, Veneziani A, Garg V, Dhani NC, Grant R, Bowering V, Oza AM, Wang L, Berlin A, Lheureux S. Electronic malignant bowel obstruction symptom monitoring smartphone application for patients with gynecologic cancers. Int J Gynecol Cancer. 2024 Oct 7;34(10):1612-1618. doi: 10.1136/ijgc-2024-005490. |
| 32217004 | Derived | Cusimano MC, Sajewycz K, Nelson M, Jivraj N, Lee YC, Bowering V, Oza A, Lheureux S, Ferguson SE. Supported self-management as a model for end-of-life care in the setting of malignant bowel obstruction: A qualitative study. Gynecol Oncol. 2020 Jun;157(3):745-753. doi: 10.1016/j.ygyno.2020.03.009. Epub 2020 Mar 23. |