Malignant intestinal obstruction

Summary

We conducted a prospective study of symptom prevalence in 206 terminally ill cancer patients and a retrospective study of the incidence and treatment of malignant intestinal obstruction in 110 patients (30 with gastric cancer, 30 with colon cancer, 30 with rectal cancer, and 20 with ovarian cancer). In the prospective study, pain was the most frequent symptom in patients surviving more than 1 month. The frequencies of general malaise, anorexia, constipation, and insomnia increased during the patient’s final month. The frequency of confusion increased during the final 2 weeks. The frequencies of agitation and death rattle increased during the final days. The incidence of intestinal obstruction was 16%. In the retrospective study, we defined malignant intestinal obstruction as a final obstruction continuing for more than 1 week and for which surgery was not indicated. Malignant intestinal obstruction developed in 63% of patients with gastric cancer, 45% with ovarian cancer, and 40% with colorectal cancer. Symptoms of malignant intestinal obstruction in many patients were successfully controlled with opioids (morphine, buprenorphine, fentanyl), anticholinergic agents (scopolamine butylbromide, scopolamine hydrobromide), a major tranquilizer (haloperidol), and a somatostatin analogue (octreotide). Nausea and vomiting due to malignant intestinal obstruction were effectively treated in 75% of patients by continuous subcutaneous infusion of octreotide, with a median dose of 300 μ g/day. However, a nasogastric tube was necessary in 33% of patients with ovarian cancer, 21% with gastric cancer, and 8% with colorectal cancer.