https://doi.org/10.4081/ecj.2026.14760
Malignant bowel obstruction in patients affected by advanced cancer: clinical and radiologic findings to support decision-making process in the emergency department
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Published: 18 February 2026
Malignant Bowel Obstruction (MBO) is an often preterminal complication of gastrointestinal and gynecological cancers. We tried to identify clinical and radiological parameters suggesting early providing of End of Life (EOL) care protocols in this kind of patients at Emergency Department (ED) presentation. We retrospectively analyzed 60 ED patients admitted for MBO in a one-year period, identifying a Bad Prognosis Group (BPG) (died or transferred to EOL care centers) and a Good Prognosis Group (GPG) (prosecution of treatment with curative intent). Predictors of bad prognosis were: time of onset of symptoms, Eastern Cooperative Oncology Group performance status (ECOG), Charlson Comorbidity Index (CCI), past intestinal obstruction, previous abdominal surgery and therapeutic strategy adopted. Computed tomography scan studies were reviewed by expert radiologists. CCI ≥ 4 (p=0,030), ECOG score ≥ 2 (p=0,016), no large bowel occlusion (p=0,045), mesenteric infiltration retraction (p=0,047) and extraperitoneal metastases (p=0,049) confirmed independent predictive value of bad prognosis at multivariate analysis. Identifying clinical and radiological criteria at ED evaluation can be useful to better identification of those MBO patients who may benefit from early providing EOL care protocols.
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1. World Health Organizaation. Ageing and health. 2019. Available at: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed December 1. 2019
2. Santucci C, Carcioli G, Bruccio P, et al. Progress in cancer mortality, incidence, and survival: a global review. Eur J Cncer Prev 2020;29: 367-81 DOI: https://doi.org/10.1097/CEJ.0000000000000594
3. Chung FR, Turecamo S, Cuthel AM ,et al. PRIME-ER Investigators (2021) Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis. Gen Intern Med 2021;36:296-304 DOI: https://doi.org/10.1007/s11606-020-06302-2
4. Cooper E, Hutchinson A, Sheikh Z, et al. Palliative care in the emergency department: a systematic literature qualitative review and thematic synthesis. Palliat Med 2018;32:1443-54. DOI: https://doi.org/10.1177/0269216318783920
5. Heufel M, Kourouche S, Wing-Shan AL, et al. End of life care pathways in the emergency department and their effects on patients ad health service outcomes: an integrated review. Int Emer Nurse 2022;61:101153. DOI: https://doi.org/10.1016/j.ienj.2022.101153
6. Australian commission on safety and quality in health care. National consensus statement: essential elements foe safe and high -quality end of life care. 2015. Accessed: 22 June 2021. Available from https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Consensus-Statement-Essential-Elements-forsafe-high quality-end-of-life-care.pdf
7. NSW Ministry of Health. End of Life and Palliative Care Framework 2019-2024. 2019. Accessed 17 July 2021. Available from: https://www.health.nsw.gov.au/palliativecare/Publications/eol-pe-framewo
8. Australasian college for emergency medicine. End of life and palliative care in the emergency department. 2020. Available from: https://acem.org.au/getmedia/d55cb8ce-2d26-49d5-823a f7f07b5c19/Policy_on_End_of_Life_and_Palliatice_Care_in_the_ ED
9. Aamado-Tineo JP, Oscanova-Espinoza T, Vasquez-Alva R, et al. Emergency department use by terminally ill patients: A sistematic review. J Pain Symptom Manage 2021;61:531-49. DOI: https://doi.org/10.1016/j.jpainsymman.2020.08.009
10. Madariaga A, Lau J, Ghostal A, et al. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer 2022;30:4711-28. DOI: https://doi.org/10.1007/s00520-022-06889-8
11. Bravington A, Boland JW, Greenlay S, e al. Exploring pathways to optimize care in malignant bowel obstruction (EPOC): protocol for a three-phase critical realis approach to theory-led intervention development for shared decision-making. PlosOne 2024;19:e0294218. DOI: https://doi.org/10.1371/journal.pone.0294218
12. Tóth R, Tóth Z, Lotti L, et al. Management of malignant bowel obstruction in patients with gynecological cancer: a systematic review. J Clin Med 2024;13:4213. DOI: https://doi.org/10.3390/jcm13144213
13. Fackche NT Johnston FM. Malignant bowel obstruction Adv Surg 2021;55:35-48. DOI: https://doi.org/10.1016/j.yasu.2021.05.003
14. Miller G, Boman J, Shrier I, et al. Small-bowel obstruction secondary to malignant disease: an 11-year audit. CJS 2020;43:353-8.
15. Ferrel BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update J Clin 2017;35:96-112. DOI: https://doi.org/10.1200/JCO.2016.70.1474
16. Vasquez DD, Spears K, Metcalfe I, et al. Time is precious: person-centered end of life care in an emergency department. A quality improvement project. Emergency Nurse 2019;27:33-42. DOI: https://doi.org/10.7748/en.2019.e1961
17. Paterson BC, Duncan R, Conway R, et al. Introduction of the Liverpool Care Pathway for end of life care to emergency medicine. Emerg Med J 2019;26:777-9. DOI: https://doi.org/10.1136/emj.2008.067249
18. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649–55. DOI: https://doi.org/10.1097/00000421-198212000-00014
19. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83. DOI: https://doi.org/10.1016/0021-9681(87)90171-8
20. Miccò M, Sbarra M, Gui B, et al. Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer. Tumori 2020;106:149-54. DOI: https://doi.org/10.1177/0300891619886657
21. Hupfeld NB, Burcharth J, Jensen TK, et al. Outcomes of patients admitted with malignant small bowel obstruction: a subgroup multicentre observational cohort analysis. Langenbeck’s Arch Surg 2024;49:239-47. DOI: https://doi.org/10.1007/s00423-024-03436-3
22. Galliano A, Schiavon S, Nard M, et al. Simultaneous care in oncology: assessment of benefit in relation to symptoms, sex, and age in 753 patients. Front Oncol 2022;12:989713. DOI: https://doi.org/10.3389/fonc.2022.989713
23. Haun MW, Estel S, Rücker G, Friederich HC, et al. Early palliative care for adults with advanced cancer, Cochrane Database Syst Rev 2017;CD011129. DOI: https://doi.org/10.1002/14651858.CD011129.pub2
24. Dionne-Odom JN, Azuero A, Lyons KD, et al. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: outcomes from ENBLE III randomized controlled trial J Clin Oncol 2015;33:1446-52. DOI: https://doi.org/10.1200/JCO.2014.58.7824
25. Agarwaal R, Epstein AS. Advance care planning and End-of Life decision making for patients with cancer. Semin Oncol Nurs 2019;34:316-26. DOI: https://doi.org/10.1016/j.soncn.2018.06.012
26. Legge 22 dicembre 2017, n. 219. Norme in materia di consenso informato e di disposizioni anticipata di trattamento (18G00006). Gazzetta Ufficiale della Repubblica Italiana n 12 del 16-01-2018.
27. Heufel M, Kourouche S, Curtis K. Development of emergency department end of life care audit: A scoping review. Int J Nurs Stud Adv 2023;14:5. DOI: https://doi.org/10.1016/j.ijnsa.2023.100143
28. Javidan AP, Hansen K, Higginson I, et al. The international federation for emergency medicine report on emergency department crowding and access block: a brief summary. Can J Emerg Med 2021;23:26-8. DOI: https://doi.org/10.1007/s43678-020-00065-9
29. George N, Baarrett N, McPeake L. Content validation of a novel screening tool to identify emergency department patients with significant palliative care needs. Acute Emer Med 2015;22:823-37. DOI: https://doi.org/10.1111/acem.12710
30. Koh MYH, Lee JFL, Montalban S, et al. ED-PALS: a comprehensive palliative care service for oncology patients in the emergency department. M J Hosp Palliat Care 2019;36:571-76. DOI: https://doi.org/10.1177/1049909119825847
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All authors contributed equally to the present article.
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