David C Currow1, Stephen Quinn2, Meera Agar3, Belinda Fazekas4, Janet Hardy5, Nikki McCaffrey6, Simon Eckermann7, Amy P Abernethy8, Katherine Clark9. 1. Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. Electronic address: david.currow@flinders.edu.au. 2. Flinders Clinical Effectiveness, Flinders University, Adelaide, South Australia, Australia. 3. Sacred Heart Hospice, Braeside Hospital, Sydney, New South Wales, Australia. 4. Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. 5. Department of Palliative and Supportive Care, Mater Health Services, South Brisbane, Queensland, Australia. 6. Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Flinders Clinical Effectiveness, Flinders University, Adelaide, South Australia, Australia. 7. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia. 8. Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Duke University Medical Center, Durham, North Carolina, USA. 9. Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
Abstract
CONTEXT: Does octreotide reduce vomiting in cancer-associated bowel obstruction? OBJECTIVES: To evaluate the net effect of adding octreotide or placebo to standardized therapies on the number of days free of vomiting for populations presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment. METHODS:Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately. In a double-blind study, participants were randomized to placebo or octreotide (600 μg/24 hours by infusion). Both arms received standardized supportive therapy (infusion of ranitidine [200 mg/24 hours], dexamethasone [8 mg/24 hours], and parenteral hydration [10-20 mL/kg/24 hours]). The primary outcome was patient-reported days free of vomiting at 72 hours. RESULTS: In a study that recruited to the numbers identified in its power calculation, 87 participants provided data at 72 hours (45, octreotide arm). Seventeen people (octreotide) and 14 (placebo) were free of vomiting for 72 hours (P = 0.67). Mean days free of vomiting were 1.87 (SD 1.10; octreotide) and 1.69 (SD 1.15; placebo; P = 0.47). An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group (incidence rate ratio = 0.40; 95% CI: 0.19-0.86; P = 0.019); however, people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide (P = 0.004), potentially reflecting increased colicky pain. CONCLUSION: Although there was no reduction in the number of days free of vomiting, the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted.
RCT Entities:
CONTEXT: Does octreotide reduce vomiting in cancer-associated bowel obstruction? OBJECTIVES: To evaluate the net effect of adding octreotide or placebo to standardized therapies on the number of days free of vomiting for populations presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment. METHODS: Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately. In a double-blind study, participants were randomized to placebo or octreotide (600 μg/24 hours by infusion). Both arms received standardized supportive therapy (infusion of ranitidine [200 mg/24 hours], dexamethasone [8 mg/24 hours], and parenteral hydration [10-20 mL/kg/24 hours]). The primary outcome was patient-reported days free of vomiting at 72 hours. RESULTS: In a study that recruited to the numbers identified in its power calculation, 87 participants provided data at 72 hours (45, octreotide arm). Seventeen people (octreotide) and 14 (placebo) were free of vomiting for 72 hours (P = 0.67). Mean days free of vomiting were 1.87 (SD 1.10; octreotide) and 1.69 (SD 1.15; placebo; P = 0.47). An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group (incidence rate ratio = 0.40; 95% CI: 0.19-0.86; P = 0.019); however, people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide (P = 0.004), potentially reflecting increased colicky pain. CONCLUSION: Although there was no reduction in the number of days free of vomiting, the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted.
Authors: Carla I Ripamonti; Andrew Davies; Eduardo Bruera; Alex Molassiotis; Declan Walsh Journal: Support Care Cancer Date: 2017-08-07 Impact factor: 3.603
Authors: Declan Walsh; Mellar Davis; Carla Ripamonti; Eduardo Bruera; Andrew Davies; Alex Molassiotis Journal: Support Care Cancer Date: 2016-08-17 Impact factor: 3.603
Authors: Margarita Romeo; Maria de Los LLanos Gil; José Luís Cuadra Urteaga; Laia Vilà; Sara Ahlal; Alberto Indacochea; Núria Pardo; Joaquim Radua; Albert Font; Albert Tuca Journal: Support Care Cancer Date: 2016-06-10 Impact factor: 3.603
Authors: Gary B Deutsch; Jeremiah L Deneve; Mazin F Al-Kasspooles; Valentine N Nfonsam; Camille C Gunderson; Angeles Alvarez Secord; Phillip Rodgers; Samantha Hendren; Eric J Silberfein; Marcia Grant; Jeff Sloan; Virginia Sun; Kathryn B Arnold; Garnet L Anderson; Robert S Krouse Journal: Am J Hosp Palliat Care Date: 2019-05-23 Impact factor: 2.500