From the Guidelines
The best approach for managing a 62-year-old patient with recurrent ovarian cancer, intestinal pseudo-obstruction, and impaired quality of life is a multidisciplinary strategy focusing on symptom management and quality of life improvement, as recommended by the most recent and highest quality study 1.
Key Considerations
- The patient's quality of life is the primary concern, and treatment decisions should be made with this in mind.
- A multidisciplinary team, including oncologists, surgeons, and palliative care specialists, should be involved in the patient's care.
- Symptom management, including pain control, bowel management, and nutritional support, is crucial.
- The patient's performance status, prognosis, and expectations should be taken into account when making treatment decisions.
Symptom Management
- Optimizing bowel function with prokinetic agents such as metoclopramide or domperidone, combined with stool softeners and osmotic laxatives, may help manage intestinal pseudo-obstruction.
- Pain control should be managed with a tiered approach, starting with non-opioid analgesics and potentially progressing to low-dose opioids.
- Nutritional support, including dietitian consultation, oral nutritional supplements, or consideration of parenteral nutrition, is essential.
Oncology Treatment Plan
- The oncology treatment plan should be reassessed, considering the patient's platinum sensitivity and potential alternatives such as liposomal doxorubicin, gemcitabine, or targeted therapies like PARP inhibitors.
- Palliative care involvement is essential for symptom management and advance care planning discussions.
Palliative Care
- Palliative care should be involved early in the patient's care to address symptom management, advance care planning, and quality of life concerns.
- The patient's goals, values, and expectations should be taken into account when making treatment decisions.
By prioritizing the patient's quality of life and involving a multidisciplinary team in their care, we can provide comprehensive management of their complex medical condition and improve their overall well-being, as supported by the evidence 1.
From the Research
Patient Profile
- 62-year-old patient with recurrent ovarian cancer
- Intestinal pseudo-obstruction due to peritoneal implants
- Impaired quality of life
- Patient was in remission for 6 years without treatment
- Decided not to have palliative chemotherapy due to medical issues and quality of life concerns
Current Symptoms
- Vomiting for several months
- Weakness for several months
- Swollen feet, dizziness, and weakness in the last month
- Diarrhea, ranging from watery to slightly solid
- Sound of water sloshing in the abdominal area
- Intestines active with sounds of liquid and waterfall
- Dizziness or lightheadedness after eating
- Struggles with walking or standing for more than 5 minutes and breathing heavily
Management Approach
- Symptomatic management of diarrhea is crucial to prevent massive electrolyte and water losses 2, 3, 4
- Antidiarrheal drugs such as loperamide, cholestyramine, bulking agents, probiotics, anticholinergic agents, and opioids can be used to manage chronic diarrhea 2, 3, 4
- A multidisciplinary approach to managing complex patients with multiple comorbidities is essential 5, 6
- Consideration of the patient's quality of life and values is critical in determining the best course of management 6
Potential Interventions
- Antidiarrheal medication to manage diarrhea
- Fluid and electrolyte replacement to prevent dehydration
- Dietary modifications to manage diarrhea and prevent malnutrition
- Pain management to address any discomfort or pain
- Multidisciplinary consultation to address the patient's complex needs and develop a comprehensive management plan 6