Risk-stratified multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in women with advanced gynaecological cancers: A prospective study.
Bibliographic record
Abstract
12076 Background: Malignant bowel obstruction (MBO) is a dreaded complication encountered in patients (pts) with advanced gynaecological cancers. Survival is short, with most pts requiring long hospital stay for managing symptoms. The aim of this study was to validate prospectively the feasibility of the MBO outpatient management by a systematic risk-stratified multidisciplinary ambulatory approach in pts with advanced gynaecological cancers. Methods: This prospective single site study enrolled pts diagnosed with or at risk of MBO due to gynaecological cancers (NCT03260647) and actively managed by the MBO interdisciplinary team including the outpatient nurse led program (PMID 31550202). Eligible pts underwent comprehensive assessments, and the team provided tailored management recommendations. Those identified as "at-risk" were systematically followed by the nursing team for 4 weeks (wks) and discharged upon complete symptom resolution. MBO patients were proactively monitored for ≥ 4 wks, transitioning to the "at-risk" category upon MBO resolution. The primary endpoint of the study was the ratio of days alive and out of the hospital to days in the hospital within the initial 60 days post-MBO diagnosis. Secondary endpoints included overall survival (OS), the rate of total parenteral nutrition (TPN) administration, and the rate of symptom resolution. Results: A total of 92 pts were enrolled, predominantly with ovarian cancer (91%), median age of 62 years (range, 31-83). At enrolment, 49% (n=45) presented with MBO, while 51% (n=47) were deemed "at risk." Proactive outpatient management by the nursing team resulted in symptom resolution in 93% of "at-risk" pts, with 7% progressing to develop MBO during the first 4 wks in the program. Throughout the study, 62% (n=57) of pts experienced MBO. At the onset of MBO, 81% (n=46) were platinum-resistant with a median of 4 prior lines of therapy (range, 0-11). While 93% of pts (n=53) required in-patient management, the median time for hospitalization durations within the first 30 and 60 days after MBO diagnosis were 7 (range, 0-30) and 12.5 (range, 0-57) days respectively. Ratio of days in hospital/days out hospital within 60 days, median (range): 0.3 (0-19). During MBO, systemic therapy was administered to 77% (n=44) of pts, predominantly with weekly paclitaxel (38%, n=21). Surgical intervention was performed in 11% of pts, included primarily diverting ileostomy in 4 pts. TPN was administered to 33% (n=19) of pts. MBO resolution occurred in 42% (n=24) pts within 60 days, with recurrent episodes in 11% (n=6) pts and MBO symptoms persisted in 58% (n=33). The median OS in pts who had an episode of MBO was 5.7 months (95% CI, 3.6-8.4). Conclusions: This study confirms the feasibility of the ambulatory MBO management with pts managed mainly outside hospital during the 60 days with reduced hospitalization days. Clinical trial information: NCT03260647 .
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".