Survival, Healthcare Utilization, and End-of-life Care Among Older Adults with Malignancy-associated Bowel Obstruction

Survival, Healthcare Utilization, and End-of-life Care Among Older Adults with Malignancy-associated Bowel Obstruction
Center for Surgery and Public Health

Malignancy associated bowel obstruction (MBO) is a late complication of intra-abdominal malignancy for which surgeons are frequently consulted. Decisions about palliative treatments, which include medical management, surgery, or venting gastrostomy tube (VGT), are hampered by the paucity of outcomes data relevant to patients approaching the end of life. Through this study of Medicare data for patients 65 years or older with stage IV ovarian or pancreatic cancer who were hospitalized for MBO, we have concluded that VGT is associated with fewer readmissions and lower intensity healthcare utilization at the end of life than medical management or surgery.

The overall median survival after the first MBO admission was less than 3 months, underscoring the relevance of end of life outcomes in delivering patient-centered care for these patients. Nonetheless, fewer than 5% had palliative care consultation. Our findings argue that because patients can expect to die in weeks to months after a diagnosis of MBO regardless of management, conversations about priorities for end of life care and discussions about treatment options in the context of these priorities are appropriate for all patients. Given the limited survival, regardless of management, hospitalization with MBO carries prognostic significance and presents a critical opportunity to identify patients’ priorities for end-of-life care

Lilley EG, Scott JW, Goldberg JE, Cauley CE, Temel JS, Epstein AS, Lipsitz SR, Smalls BL, Haider AL, Bader AM, Weissman JS, Cooper Z. Survival, Healthcare Utilization, and End-of-Life Care among Older Adults with Malignancy-associated Bowel Obstruction: Comparative Study of Surgery, Venting Gastromy, or Medical Management. Ann Surg. 2017.