Impact of treatment strategy after malignant bowel obstruction in stage IV gastrointestinal cancer: population-based cohort study
Bibliographic record
Abstract
BACKGROUND: Malignant bowel obstruction in patients with stage IV gastrointestinal cancer represents a challenging scenario, with a lack of patient-centred outcome data to guide decisions. This study evaluated the association between days at home, and malignant bowel obstruction palliation treatment strategy in this subgroup of patients. METHODS: This population-based retrospective cohort study included adults with stage IV gastrointestinal cancer admitted for malignant bowel obstruction between 2010 and 2019. Patients with stage IV gastrointestinal cancer treated with curative intent were excluded. The primary exposure was treatment strategy at first admission with malignant bowel obstruction divided into surgical, procedural (percutaneous or endoscopic), and supportive care. The primary outcome of interest was days at home over 90 days. Multivariable quantile regression was used to evaluate the association between treatment strategy and days at home over 90 days adjusted for cancer and patient factors. Quantile plots were used to examine this association across the distribution of days at home over 90 days. RESULTS: Of 12 923 patients admitted, 4642 were selected: 2076 (44.7%) received surgical, 310 (6.7%) procedural, and 2256 (48.6%) supportive care. Those who had surgical treatment had the highest median days at home over 90 days of 67 (interquartile range 23-80) days, followed 45 (7-78) days with procedural treatment, and 31 (0-76) days with supportive care. After adjusting for patient and cancer factors, surgical treatment was associated with an increase in median days at home over 90 days of 20 (95% confidence interval 15-24) days and procedural treatment with an increase of 14 (6-22) days. The directionality of these findings was stable across the distribution of days at home over 90 days, and stable in sensitivity analysis after exclusion of deaths. CONCLUSION: Surgical and procedural treatment were associated with increased days at home over 90 days. These findings can support decision-making and expectation setting in patients eligible for surgical and procedural treatments.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".