Disparities and predictors of survival in non-surgical management of malignant bowel obstruction: Insights from a Southwestern US cohort.

Abstract

e16470 Background: Malignant bowel obstruction (MBO) is a severe complication in advanced cancer, affecting up to 15% of patients. It is managed with antiemetics, corticosteroids, and antisecretory agents, though evidence remains limited. The lack of standardized protocols, particularly for conservative management, contributes to variability in care. This study investigates survival predictors and treatment disparities in MBO management in a diverse Southwestern U.S. population. Methods: A retrospective cohort study was conducted on 63 patients with MBO treated non-operatively between July 2019 and June 2023 at a Southwestern U.S. medical center. Of 421 patients screened, exclusions were based on incomplete records or failure to meet clinical and radiological criteria for MBO. Data included demographics, tumor types, treatments, inflammatory markers, and outcomes. Statistical analyses included t-tests, logistic regression, and adjusted odds ratios (OR) with 95% confidence intervals (CI). Length of stay (LOS) and survival duration were analyzed using mean differences. Subgroup comparisons identified disparities across gender, ethnicity, and language preference. Results: The cohort included 39 females (61.9%) and 24 males (38.1%) with a mean age of 63.2 years (SD = 13.8). The most common causes of MBO were GI tumors (46%) and gynecologic cancers (34%). The median survival was 25 days, with significant disparities observed. Non-English speakers had higher odds of survival (OR = 5.56, p = 0.035), while sepsis at admission was associated with 100% mortality. Elevated CRP (15.85 vs. 8.78 days, p = 0.061), steroid use (11.36 vs. 9.92 days, p = 0.147), NG tube placement (10.95 vs. 9 days, p = 0.112), and parenteral hydration (12.55 vs. 9.16 days, p = 0.367) were associated with longer LOS, though these differences did not reach statistical significance. Higher BMI correlated positively with survival (25.8 vs. 24.3, p = 0.032). Female patients were more likely to receive NG tubes (OR = 3.05, p = 0.050) and achieve non-surgical resolution (OR = 3.45, p = 0.041) but were less likely to enroll in hospice (OR = 0.17, p = 0.003). Steroids (22.2%) and octreotide (11.1%) were underutilized despite their role in symptom management. Conclusions: Disparities in MBO management highlight gaps in equitable care, particularly for gender and language preference. Non-English-speaking patients had a survival advantage, underscoring the importance of culturally tailored care. The underutilization of palliative treatments, such as steroids and octreotide, reveals inconsistencies in guideline adherence. The association of sepsis with 100% mortality reinforces the need for early infection management. Standardized, evidence-based protocols and culturally appropriate care could improve outcomes for this high-risk population.