Authors
  • Timothy To1,
  • Meera Agar2,
  • Debra Rowett3,
  • David Currow4
Organisations
  • Repatriation General Hospital, Adelaide1,
  • Braeside Hospital2,
  • Southern Adelaide Palliative Services3,
  • Flinders University4
Year

2012

Excerpt

Malignant bowel obstruction (MBO) can be a distressing and debilitating complication for palliative care patients. The management of MBO is not standardised. The choice of non-pharmacological or pharmacological therapies is clinician dependent. The aim of this national survey was to examine the prescribing preferences of palliative medicine clinicians for the treatment of MBO.

A cross-sectional online survey was sent out to Australian palliative medicine clinicians. Participants were presented with a clinical vignette about a patient with metastatic ovarian cancer with extensive intra-abdominal disease with an acute MBO to be treated medically. Participants were asked about the use of non-pharmacological measures, and the first agent of choice for treatment, dosing and review schedules, maximum doses, and possible side effects. Participants were asked to offer the same information about their choice for second agent of choice.

One hundred and five participants responded with 97 first and 95 second line treatment choices. The majority would insert a nasogastric tube and leave on free drainage. Twelve medications were nominated. Haloperidol, followed by dexamethasone and hyoscine butylbromide, was the most common first line treatment, and octreotide and cyclizine the second line treatments. There were considerable variations in starting and maximal doses, however most would review patients by 24 hours. The median maximal total daily dose of haloperidol, dexamethasone, hyoscine butylbromide, octreotide and cyclizine were Smg (IQR S-10), 16mg (IQR 12-16), 120mg (IQR 8S-22S), 900mcg (IQR 600-1000mcg) and 200mg (IQR lS0-300) respectively.

There were large variations in the treatment of malignant bowel obstruction amongst palliative care clinicians. Even for a single medication, the dosing was inconsistent. This highlights the need for well-designed studies of malignant bowel obstruction treatment in palliative care patients to guide treatment choices and dosing.