Gastrointestinal obstruction in palliative care: a review

Many symptoms are experienced by dying patients. Any symptom can be debilitating and affect the patient’s and the family’s quality of life. Symptom research is complicated, especially in patients receiving palliative care because the studies needed are methodologically challenging. Symptoms management is the essential goal in palliative care. Many people rate this as one of the most important issues whether they are at home, in a hospital or at other assisted care. Bowel obstruction is rarely an emergency, and usually evaluated by multidisciplinary teams. Tailored management is based on the underlying aetiology and pathophysiology. When several symptoms occur together, they can be interrelated and management can be complex. This article discusses the management of intestinal obstruction experienced by palliative care patient

End-of-life palliative chemotherapy: Where do we stand?

Background: This study evaluates the use of palliative chemotherapy (PCT) and possible associated factors at the end of life. Method: The study includes all advanced non hematological cancer patients who died in the King Abdullah Medical City during the period from January 2011 to April 2014. Demographic and disease features were registered. Results: 420 patients were included in the study, median age 62 years (range 17–108); 52% female and 48% male. 87.4% of patients were Saudis and 12.6% non Saudis. 124 (29.5%) patients received PCT at the last month before death (LM-PCT): 21.8%, 22.6% and 55.6% within one, two and four weeks of death, respectively. Place of death (critical care vs. regular ward) and mode of admission (ER vs. OPD vs. Transferred) had a strong association with LM-PCT (p < 0.0001, ϕ = 0.35) and (p < 0.0001, V = 0.43), respectively. There was a gradual increase in the number of patients receiving LM-PCT from January 2011 to April 2014; 15.3%, 28.2%, 37.1% and 19.4%, respectively. Conclusion: In our center; at the end of life, there is a gradual increase in the number of patients receiving chemotherapy which significantly increased cancer patients’ odds without clear predictive factors associated with its use, which calls into question the benefits of PCT in terminally ill cancer patients

Impact of body mass index on clinico-pathological parameters and outcome in patients with metastatic prostate cancer

Background: This study evaluates the correlation between body mass index (BMI) and clinicopathological parameters of metastatic prostate cancer (MPC) and its impact on survival. Method: During the study period, 71 MPC patients were eligible. Patients with BMI < 25.0 kg/m2 were categorized as level I and patients with BMI ⩾ 25.0 kg/m2 were categorized as level II. Demographic features and survival rates were evaluated by the Kaplan–Meier method and Cox proportional models. Results: 31 patients belonged to level I while the rest belonged to level II with insignificant higher median follow-up duration in level II; p = 0.5. In terms of age, metastasis, serum level of albumin, prostatic specific antigen, alkaline phosphatase (AKP) and Gleason score, there was no significant difference between the two levels. The cumulative survival probability in the 12th, 24th and 36th month in level I vs; level II was; 86.7%, 68.7%, 64.1% vs; 74.4%, 67.7%, 55.1%, respectively with 7 patients dead in level I compared to 14 patients dead in level II denoting a higher PC-specific death rate in the level II group. In univariate and multivariate analysis, poor prognosis was associated with increasing AKP (HR = 1.0005, 95% CI, p = 0.03; HR = 1.001, 95% CI, p = 0.03) respectively, while better prognosis was associated with no visceral metastasis (HR = 0.09, 95% CI, p = 0.000; HR = 0.04, 95% CI, p = 0.000) and increasing albumin levels (HR = 0.17, 95% CI, p = 0.000; HR = 0.15, 95% CI, p = 0.000) respectively. In multivariate analysis only, patients belonging to level I were associated with better prognosis (HR = 0.17, 95% CI, p = 0.02). Conclusion: BMI is dependent on prognostic factors in patients with MPC