Most effective treatment for early haemostasis and preventing re-bleeding in cancer patients with upper GI bleeds?

Doyle, Christopher, Mann, Mala, Byrne, Anthony and Sui, Jessica 2024. Most effective treatment for early haemostasis and preventing re-bleeding in cancer patients with upper GI bleeds? Presented at: 13th World Research Congress of the European Association for Palliative Care, 16-18 May 2024, Barcelona, Spain. Palliative Medicine. , vol.38 (1 (Sup) pp. 1-280. 10.1177/02692163241242338

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Abstract

Background/aims: https://walescancerresearchcentre.org/wp-content/uploads/Upper-GI-bleeds_rapid-review.pdf The aim of this rapid review was to examine the evidence base for achieving immediate haemostasis in patients with upper GI malignant bleeding requiring hospitalization. Methods: Study selection was based upon review of the abstract by two independent reviewers. The full text was then assessed independently using a pre-designed eligibility form according to inclusion criteria. Data extraction was carried out within a pre-agreed form, initially piloted with one article. Critical appraisal of studies was carried out using the relevant study design tool. Any discrepancies between the two reviewers were resolved by consensus or by recourse to a third reviewer. Results: Of 1,035 references initially identified 18 studies are included in this review. Two of the papers had study centres in the UK, however, the majority were in healthcare systems not directly comparable to the UK. Of the new studies, six focused on the use of radiotherapy to stop UGI tumour bleeds, three studies used a haemostatic spray and one focused on the use of a Proton Pump Inhibitor (PPI). External beam radiotherapy appears best placed to maintain haemostasis once initial haemostasis (with haemostatic sprays being most effective in achieving this) has been achieved and is widely accessible in the UK. Conclusions: Overall limitations such as small sample sizes, recall bias, lack of information on missing data, and very heterogeneous study designs (participant populations, intervention type, outcomes and timing of outcome measurements) preclude more definitive recommendations. RCTs have been difficult in palliative patients due to factors including recruitment, attrition and randomisation and the ethical concerns this may raise however a well designed RCT may provide improved evidence of clinical effectiveness of an intervention using a comparator group, and collect more robust evidence on cost-effectiveness and safety.

Item Type:	Conference or Workshop Item (Paper)
Date Type:	Published Online
Status:	Published
Schools:	Academic & Student Support Service Medicine Marie Curie Palliative Care Research Centre (MCPCRC)
Funders:	Marie Curie Cancer Care core grant
Last Modified:	14 Jan 2025 13:15
URI:	https://orca.cardiff.ac.uk/id/eprint/174372

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