Gynecology cancer team
Some members of The Inter-professional Malignant Bowel Management Program at Princess Margaret Cancer Centre. (Photo: UHN)

The gynecology oncology team at Princess Margaret Cancer Centre today received the 2018 Quality Award from the Cancer Quality Council of Ontario for its proactive approach to helping women with advanced cancers manage malignant bowel obstruction (MBO), a complication that can be life-threatening.

The team partnered closely with patients to design and develop The Inter-professional Malignant Bowel Management Program to help patients and families navigate the difficult and stressful challenge of MBO, which can require frequent visits to the emergency department and hospitalizations.

A patient with unquenchable thirst to know more about her ovarian cancer, plus spirited determination to partner with her clinical team every step of the way, was among those who inspired the gynecologic oncology team at Princess Margaret Cancer Centre to create an innovative program to help women manage MBO.

The patient, Tammy Snow of Georgetown, who has been hospitalized several times with MBO, was delighted to hear the news about "her" team.

"I would keep asking 'can't we go outside the box and try something different?'" she says. "I had to be a partner in my own care and invested in my well-being."

Her physician, Dr. Stephanie Lheureux, the medical oncologist leading the gynecology disease site group, says: "I continue to be inspired by Tammy and my patients. She pushed this program into action.

"The team decided to turn this very complex problem of MBO into an opportunity for action and fill the gap with a dedicated program," Dr. Lheureux says. "We wanted to find ways to avoid prolonged hospitalizations and improve quality of life for our patients by providing proactive, preventive screening with a focus on wellness.

"We want to empower patients to self-manage bowel symptoms and reduce their anxiety by assuring them that the team is there for them."

The result?

In 2016, an interprofessional team of leaders from, medical oncology, gynecology oncology, general surgery, radiation, nursing, dietary, pharmacy, palliative care, psychosocial and clinical trials developed and implemented the program for patients who either had or were at risk of developing MBO. The program consists of standardized tools, processes and education that assess the needs of patients at risk.

Daily proactive calls

One of the standardized tools and processes is a novel nurse-led, color-coded algorithm that assesses and identifies patients with or at risk of MBO. This tool was the outcome of the Thompson Collaborative Academic Practice (CAP) Nursing Innovation Fellowship, received by Nazlin Jivraj. Through the CAP fellowship, nurses developed a standardized assessment form and patient education materials.

To improve care by monitoring and managing changes in symptoms, the nurses also make daily proactive calls – 700 calls by the end of 2017. Patients can also call in for advice as needed – a link back to the team that Tammy often uses.

Like other women participating in this program, Tammy knows she will get a phone call every Monday and often again on Wednesday from a specialized oncology nurse.

"I feel so cared for and the support is amazing. Princess Margaret is where the sun shines for me," says Tammy, who was diagnosed in 2011 at age 42. She has had surgery, 40-plus chemotherapy treatments, and has also participated in clinical trials. These days she receives all her nutrition intravenously for 12 hours every night at home.

On the wellness front, Tammy meditates, enjoys daily walks and yoga and stretching.

"Sometimes it isn't easy, but I keep moving forward," she says. "The hardest part is to stay positive but I don't let my cancer define me.

"And I'm determined to get to Newfoundland in July!"

Dr. Lheureux says: "It's remarkable and gratifying to see how patients can manage at home with support in dealing with this common and challenging clinical complication.

"It is our mission to help our patients through this difficult journey."

To date, 235 patients have been treated in the MBO program, which is now standard of care at University Health Network. Next, the team is conducting a prospective clinical study (NCT03260647) with enrolled patients to assess the impact of the MBO program. ​

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