Risk-stratified multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in women with advanced gynaecological cancers: A prospective study.
Authors: Garg Vikas , Alqaisi Husam , Soberanis Pina Pamela , Veneziani Ana , Pannu Anmol Kaur , Grant Brooke , Braik Dina , Wang Crystal , Shukla Arundhati , Tesfu Azieb , Odujoko Oyinlade , Madariaga Ainhoa , Lee Yeh Chen , Wang Lisa , Jivraj Nazlin , Bowering Valerie , Grant Robert C , Dhani Neesha C. , Oza Amit M. , Lheureux Stephanie 
Published: June 2024

12076

Background: Malignant bowel obstruction (MBO) is a dreaded complication encountered in patients (pts) with advanced gynaecological cancers. Survival is short, with most pts requiring long hospital stay for managing symptoms. The aim of this study was to validate prospectively the feasibility of the MBO outpatient management by a systematic risk-stratified multidisciplinary ambulatory approach in pts with advanced gynaecological cancers. Methods: This prospective single site study enrolled pts diagnosed with or at risk of MBO due to gynaecological cancers (NCT03260647) and actively managed by the MBO interdisciplinary team including the outpatient nurse led program (PMID 31550202). Eligible pts underwent comprehensive assessments, and the team provided tailored management recommendations. Those identified as "at-risk" were systematically followed by the nursing team for 4 weeks (wks) and discharged upon complete symptom resolution. MBO patients were proactively monitored for ≥ 4 wks, transitioning to the "at-risk" category upon MBO resolution. The primary endpoint of the study was the ratio of days alive and out of the hospital to days in the hospital within the initial 60 days post-MBO diagnosis. Secondary endpoints included overall survival (OS), the rate of total parenteral nutrition (TPN) administration, and the rate of symptom resolution. Results: A total of 92 pts were enrolled, predominantly with ovarian cancer (91%), median age of 62 years (range, 31-83). At enrolment, 49% (n=45) presented with MBO, while 51% (n=47) were deemed "at risk." Proactive outpatient management by the nursing team resulted in symptom resolution in 93% of "at-risk" pts, with 7% progressing to develop MBO during the first 4 wks in the program. Throughout the study, 62% (n=57) of pts experienced MBO. At the onset of MBO, 81% (n=46) were platinum-resistant with a median of 4 prior lines of therapy (range, 0-11). While 93% of pts (n=53) required in-patient management, the median time for hospitalization durations within the first 30 and 60 days after MBO diagnosis were 7 (range, 0-30) and 12.5 (range, 0-57) days respectively. Ratio of days in hospital/days out hospital within 60 days, median (range): 0.3 (0-19). During MBO, systemic therapy was administered to 77% (n=44) of pts, predominantly with weekly paclitaxel (38%, n=21). Surgical intervention was performed in 11% of pts, included primarily diverting ileostomy in 4 pts. TPN was administered to 33% (n=19) of pts. MBO resolution occurred in 42% (n=24) pts within 60 days, with recurrent episodes in 11% (n=6) pts and MBO symptoms persisted in 58% (n=33). The median OS in pts who had an episode of MBO was 5.7 months (95% CI, 3.6-8.4). Conclusions: This study confirms the feasibility of the ambulatory MBO management with pts managed mainly outside hospital during the 60 days with reduced hospitalization days. Clinical trial information: NCT03260647 .