• J Pain Symptom Manage · Feb 2018

    Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of H2-blockers/proton pump inhibitors and corticosteroids with octreotide.

    • Takaaki Minoura, Masato Takeuchi, Tatsuya Morita, and Koji Kawakami.
    • Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
    • J Pain Symptom Manage. 2018 Feb 1; 55 (2): 413-419.e2.

    ContextMalignant bowel obstruction impairs the quality of life in patients with advanced cancer. Octreotide, acid-suppressing medications such as H2-receptor antagonists (H2-blockers) and proton pump inhibitors (PPIs), and corticosteroids are often used in combination for symptom control.ObjectivesWe evaluated the practice patterns of medications for patients hospitalized with malignant bowel obstruction using a large claims database in Japan. In addition, we explored the association of adding H2-blockers/PPIs or corticosteroids to octreotide on treatment outcomes.MethodsWe analyzed data from a nationwide medical claims database from April 2010 to March 2015 containing 975,000 patients. We included all adult inpatients with cancer who used octreotide 300 μg/day or more and summarized each patient's medication use. We also assessed whether concomitant use of H2-blockers/PPIs or corticosteroids was associated with the number of days of nasogastric tube (NGT) insertion; logistic regression was used to adjust the patients' baseline factors.ResultsWe included 3090 patients; octreotide alone was used in 1649 (53%) cases. A combination of octreotide and H2-blockers or PPIs was used in 419 and 337 cases (14% and 11%), respectively; a combination of octreotide and corticosteroids was used in 374 cases (12%). Of the 1595 patients who underwent NGT insertion, those using corticosteroids with octreotide had a higher odds ratio of NGT removal within four days of insertion (adjusted odds ratio = 1.16; 95% CI = 1.08-1.23).ConclusionOctreotide alone was used in the majority of patients, and the concomitant use of corticosteroids was more likely to be associated with early NGT removal.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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