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

Patterson, Michael; Greenley, Sarah; Ma, Yangmyung; Bullock, Alex; Curry, Jordan; Smithson, Jacquelyn; Lind, Michael; Johnson, Miriam J.

Abstract

Background: Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) are two interventions used clinically to manage inoperable malignant bowel obstruction (MBO); however, little is known about their role in clinical and quality-of-life outcomes to inform clinical decision making. Aim: To examine the impact of PN and PVG on clinical and quality-of-life outcomes in inoperable MBO. Design: A mixed-methods systematic review and narrative synthesis. Data sources: The following databases were searched (from inception to 29 April 2021): MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Bielefeld Academic Search Engine, Health Technology Assessment and CareSearch for qualitative or quantitative studies of MBO, and PN or PVG. Titles, abstracts and papers were independently screened and quality appraised. Results: A total of 47 studies representing 3538 participants were included. Current evidence cannot tell us whether these interventions improve MBO survival, but this was a firm belief by patients and clinicians informing their decision. Both interventions appear to allow patients valuable time at home. PVG provides relief from nausea and vomiting. Both interventions improve quality of life but not without significant burdens. Nutritional and performance status may be maintained or improved with PN. Conclusion: PN and PVG seem to allow valuable time at home. We found no conclusive evidence to show either intervention prolonged survival, due to the lack of randomised controlled trials that have to date not been performed due to concerns about equipoise. Well-designed studies regarding survival for both interventions are needed. PROSPERO registration number: CRD42020164170.

Citation

Patterson, M., Greenley, S., Ma, Y., Bullock, A., Curry, J., Smithson, J., …Johnson, M. J. (2022). Inoperable malignant bowel obstruction: palliative interventions outcomes-mixed-methods systematic review. BMJ supportive & palliative care, Article 003492. https://doi.org/10.1136/bmjspcare-2021-003492

• Journal Article Type: Review
• Acceptance Date: May 27, 2022
• Online Publication Date: Jul 19, 2022
• Publication Date: 2022
• Deposit Date: Jul 26, 2022
• Publicly Available Date: Jul 27, 2022
• Journal: BMJ Supportive and Palliative Care
• Print ISSN: 2045-435X
• Electronic ISSN: 2045-4368
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Article Number: 003492
• DOI: https://doi.org/10.1136/bmjspcare-2021-003492
• Keywords: Medical–Surgical Nursing; Oncology (nursing); General Medicine; Medicine (miscellaneous)
• Public URL: https://hull-repository.worktribe.com/output/4040505
• Additional Information: PROSPERO registration number CRD42020164170