Dexamethasone and clinical outcomes in malignant intestinal obstruction: A retrospective cohort study

Main Article Content

Payud Manprasert
Jiratha Budkaew
Bandit Chumworathayi

Abstract

The benefit of glucocorticoids is still inconclusive although many guidelines recommend using glucocorticoids in malignant intestinal obstruction. This study aimed to identify the efficacy of dexamethasone for clinical outcomes in malignant intestinal obstruction in a tertiary care hospital by retrospective cohort study. One hundred and forty-two patients were admitted for malignant intestinal obstruction, from January 2013 to July 2018, diagnosed by signs and symptoms, confirmed by radiologic imaging, and consequently investigated. The primary outcome was the change of vomiting at day four while the secondary outcome focused on the change of other clinical events at day four. Mean changes, 95% CIs, and comparison tests, were used to analyze. Dexamethasone users’ group was found to be associated with a higher mean change number of vomiting at day four [-3.0 (-4.3, -1.6) vs -1.0 (-1.3, -0.6), p<0.05] and a higher mean change of pain scores at day four [-5.4 (-6.2, -4.5) vs -1.8 (-2.3, -1.2), p<0.05]. Moreover, dexamethasone users’ group was proven to have a higher proportion of improved vomiting (80.8% vs 33.9%, p<0.05), a higher proportion of improved ability to pass stool (88.5% vs 35.7%, p<0.05), a higher proportion of improved abdominal pain at day four (96.2% vs 61.8%, p<0.05). In patients with malignant intestinal obstruction, dexamethasone was found to be associated with a higher mean change number of vomiting at day four, and a higher proportion of improved clinical outcomes at day four. Our investigation established the possible benefits of dexamethasone in malignant intestinal obstruction.

Article Details

How to Cite
Manprasert, P., Budkaew, J., & Chumworathayi, B. (2021). Dexamethasone and clinical outcomes in malignant intestinal obstruction: A retrospective cohort study. Asia-Pacific Journal of Science and Technology, 27(01), APST–27. https://doi.org/10.14456/apst.2022.7
Section
Research Articles

References

Ripamonti CI, Mercadante S. Pathophysiology and management of malignant bowel obstruction. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford Textbook of Palliative Medicine, 3rd ed. New York: Oxford University Press; 2004. p. 496-507.

Ripamonti C, Twycross R, Baines M, Bozzetti F, Capri S, De Conno F, et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9(4):223-233.

Tuca A, Guell E, Losada EM, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012;4:159-169.

Mercadante S. Palliative care of bowel obstruction in cancer patients [Internet]. Massachusetts; UpToDate, Inc; 2020 [Cited 2020 Oct 15]. Available from: https://www.uptodate.com/contents/palliativ

e-care-of-bowel-obstruction-in-cancer-patients.

Cousins SE, Tempest E, Feuer DJ. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2016;2016(1):CD002764.

Patel A, Garg R. Role of steroids in malignant bowel obstruction. Palliat Med Hosp Care Open J. 2016; 2(2):30-36.

Dans M, Smith T, Back A, Baker JN, Bauman JR, Beck AC, et al. NCCN Guidelines Insights: Palliative Care, Version 2.2017. J Natl Compr Canc Netw. 2017;15(8):989-997.

Hardy J, Ling J, Mansi J, Isaacs R, Bliss J, A’Hern R, et al. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med. 1998;12(6):437-442.

Laval G, Girardier J, Lassaunière JM, Leduc B, Haond C, Schaerer R. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction?. Palliat Med. 2000;14(1):3-10.

Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;2000(2):CD001219.

Steindel SJ. International classification of diseases, 10th edition, clinical modification and procedure coding system: descriptive overview of the next generation HIPAA code sets. J Am Med Inform Assoc. 2010;17(3):274-282.