Factors involved in gastrointestinal bleeding in advanced cancer patients followed at home.

There is a lack of information on the frequency of symptomatic gastrointestinal bleeding in patients with advanced cancer. This group of patients presents several risk factors for developing gastrointestinal bleeding. The aim of this multicenter longitudinal survey was to assess the frequency of gastrointestinal bleeding and possible factors implicated in advanced cancer patients followed at home. A consecutive sample of 439 patients who referred to home palliative care program entered the study. Age, gender, primary cancer and known metastases, possible associated pathologies, history of peptic disease, use of previous or actual nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids, drugs used to prevent gastric complications, the occurrence of hematemesis or melena, significant anemia requiring blood transfusion, and mortality associated with the hemorrhagic event were recorded. Of 377 patients who completed the study, 18 reported gastrointestinal bleeding, and five had significant anemia requiring blood transfusion in three cases. Death was found to be related to bleeding in three patients. NSAIDs, steroids, and gastroprotectors were frequently used, either before or during home care. However, no clear relationship between age, gender, and the use of offender drugs with gastrointestinal bleeding was found. Liver involvement was frequently associated with the risk of developing gastrointestinal bleeding.