Malignant Bowel Obstruction in Advanced Gynecologic Cancers

Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective
Obstetrics and Gynecology International 2018
MBO is a challenging complication of advanced gynecologic cancers, particularly in ovarian cancer. Clinical decision making involves complex considerations of different approaches with limited guidance available from the current literature. Only a small subset of patients with MBO appears to benefit from surgical interventions, and there is ongoing controversy with the use of chemotherapy and TPN, highlighting the need for further investigation. The majority of patients with MBO are treated with the medical management focusing on symptom control and quality of life. Early integration of palliative care is essential in the management of MBO symptoms and facilitates discussions addressing treatment expectations and goals of care.
Patients with MBO can be managed in an out-patient setting by the hospital specialist team with the support from community care services, such as home palliative care services, community nursing care, and domestic care services. This ambulatory model of care appears feasible and allows patients to be supported at home . Patients with MBO can be closely monitored by a team of physicians and nurses who can manage their symptoms accordingly, thereby alleviating unnecessary emergency department visits. Education about MBO is also the key to empower patients (and their caregivers) to be confident in managing their symptoms and when to seek help.