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 H 2 -Blockers/Proton Pump Inhibitors and Corticosteroids With Octreotide.

CONTEXT: Malignant 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.

OBJECTIVES: We 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.

METHODS: We 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.

RESULTS: We 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).

CONCLUSION: Octreotide alone was used in the majority of patients, and the concomitant use of corticosteroids was more likely to be associated with early NGT removal.