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Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction

Currow, David C., Quinn, Stephen, Agar, Meera, Fazekas, Belinda, Hardy, Janet, McCaffrey, Nikki, Eckermann, Simon, Abernethy, Amy P. and Clark, Katherine 2015, Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction, Journal of pain and symptom management, vol. 49, no. 5, pp. 814-821, doi: 10.1016/j.jpainsymman.2014.09.013.

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Title Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction
Author(s) Currow, David C.
Quinn, Stephen
Agar, Meera
Fazekas, Belinda
Hardy, Janet
McCaffrey, NikkiORCID iD for McCaffrey, Nikki orcid.org/0000-0003-3684-3723
Eckermann, Simon
Abernethy, Amy P.
Clark, Katherine
Journal name Journal of pain and symptom management
Volume number 49
Issue number 5
Start page 814
End page 821
Total pages 8
Publisher Elsevier
Place of publication Amsterdam, The Netherlands
Publication date 2015-05
ISSN 0885-3924
1873-6513
Keyword(s) Malignant bowel obstruction
net clinical benefit
octreotide
palliative care
randomized controlled trial
vomiting
Antineoplastic Agents, Hormonal
Australia
Comorbidity
Double-Blind Method
Female
Gastrointestinal Agents
Humans
Intestinal Neoplasms
Intestinal Obstruction
Male
Middle Aged
Placebo Effect
Prevalence
Risk Factors
Survival Rate
Treatment Outcome
Summary 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.
Language eng
DOI 10.1016/j.jpainsymman.2014.09.013
Field of Research 111299 Oncology and Carcinogenesis not elsewhere classified
11 Medical And Health Sciences
Socio Economic Objective 0 Not Applicable
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, American Academy of Hospice and Palliative Care
Free to Read? Yes
Use Rights Creative Commons Attribution Non-Commercial No-Derivatives licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30093400

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.