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Efficacy of dexamethasone in the management of malignant small bowel obstruction in advanced epithelial ovarian cancer

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Abstract

Introduction

Malignant small bowel obstruction (MSBO) occurs in up to 50% of women with advanced epithelial ovarian cancer (EOC) causing symptom burden and distress to women and their families, particularly in the terminal stages of the disease. Corticosteroids are used to promote symptom resolution in malignant small bowel obstruction (MSBO) related to EOC, with little published data on their efficacy, optimal dosing and duration of treatment.

Objective

To evaluate the efficacy of dexamethasone in achieving symptom control in women with advanced EOC presenting with MSBO, assess dexamethasone dosing and efficacy over subsequent presentations, and examine differences in dexamethasone responsiveness between platinum-resistant and platinum-sensitive patient.

Methods

This is a retrospective cohort study of women presenting with MSBO due to advanced EOC over a 12-year period from January 2005 to December 2016 in a single tertiary hospital.

Results

Ninety-one women with MSBO were administered dexamethasone over 154 admissions with 89% of women initially achieving partial or complete symptom control. Dexamethasone responsiveness did not change with recurrent admissions, and platinum responsive patients were more likely to respond to dexamethasone than platinum-resistant patients (OR 3.6 [95%CI 1.1 to 12.2, p = 0.04]). A total of 15.6% of patients required additional measures to control symptoms of MSBO, and 44.8% had adequate symptom resolution to allow them to remain on or commence further treatment for EOC.

Conclusion

Dexamethasone therapy is a useful adjunctive therapy in the management of symptoms associated with MSBO in women with EOC.

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Data Availability

Data was obtained from the patients’ medical record.

Code availability

Statistical analysis was performed using Stata v16 statistical software (StataCorp. 2019. Stata Statistical Software: Release 16. College Station, T. USA).

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Authors and Affiliations

  1. Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, VIC, 3078, Australia

    Antonia P. M. Jones, Monica F. G. McGauran, Simon Hyde & Peter Grant

  2. Department of Gynaecological Oncology, Royal Women’s Hospital, Parkville, VIC, Australia

    Antonia P. M. Jones

  3. Department of Gynaecological Oncology, Mater Hospital, South Brisbane, QLD, Australia

    Nisha Jagasia

  4. Translational Obstetrics Group, University of Melbourne, Heidelberg, VIC, Australia

    Richard J. Hiscock

  5. Mercy Perinatal, Mercy Hospital for Women, Heidelberg, VIC, Australia

    Richard J. Hiscock

  6. Department of Anaesthetics, Mercy Hospital for Women, Heidelberg, VIC, Australia

    Richard J. Hiscock

Authors
  1. Antonia P. M. Jones
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  2. Monica F. G. McGauran
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  3. Nisha Jagasia
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  4. Richard J. Hiscock
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  5. Simon Hyde
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  6. Peter Grant
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Contributions

All the authors contributed to the study conception and design. Data collection performed by AJ, MM and NJ. Analysis was performed by RH. The first draft of the manuscript was written by AJ, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Monica F. G. McGauran.

Ethics declarations

Ethics approval

Ethics approval was obtained from the Mercy Health Human Research Ethics Committee. (Reference number R16/50, approved 11 October 2016).

Consent to participate

As retrospective data was obtained from the medical record, the need to obtain consent to participate was waived by the Mercy Health HREC.

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N/A

Competing interests

The authors declare no competing interests.

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Jones, A.P.M., McGauran, M.F.G., Jagasia, N. et al. Efficacy of dexamethasone in the management of malignant small bowel obstruction in advanced epithelial ovarian cancer. Support Care Cancer 30, 2821–2827 (2022). https://doi.org/10.1007/s00520-021-06694-9

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  • DOI: https://doi.org/10.1007/s00520-021-06694-9

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