NUTRITIONAL CARE PATHWAYS OF PATIENTS WITH MALIGNANT BOWEL OBSTRUCTION: EXPERIENCE FROM A UK TERTIARY-REFERRAL CENTRE

Introduction Emerging evidence is gathering for the use of parenteral nutrition (PN) in patients with malignant bowel obstruction (MBO) who have lost nutritional autonomy and developed Intestinal Failure (IF). There is limited evidence describing the outcomes for MBO patients who are not referred for PN. We aimed to examine nutritional care pathways of MBO patients by referral for PN and appropriateness of referral/non-referral for PN. Methods Retrospective cohort study of adults (≥18yrs) admitted to University College London Hospital, admitted with MBO between 1.1.16- 31.12.16 with any readmissions up to 31.12.17. Data were analysed by comparing patients who were referred (R) and not referred (NR) for PN. Results 72 patients with 117 MBO admissions (mean±SD age: 63.1±13.1yrs, 79% female), with median no. of admissions/patient: 1 (range: 1–6). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and gastrointestinal (76%). 83% of MBO patients had metastases and 61% were located subdiaphragmatically. All patients were at high risk of malnutrition using UCLH nutrition screening tool (score=8, a score of ≥7 indicates high risk of malnutrition) and mean weight loss on admission was 7%. Discussion of PN at MDT (21 vs. 4%, P=0.02) and dietetic contact (94 vs 41%, P Conclusion All MBO patients presented with high risk of malnutrition on admission. Less than half were referred for PN. Patients who received a dietetic review and when PN was discussed at MDT were more likely to be referred for PN. It was unclear in some cases why patients were not referred for PN. This suggest that timing of referral and integration of nutritional care, not just PN, into clinical management discussion at MDT is crucial. Not all patients referred to the Nutrition team were discharged on HPN based on judicious review of each case.