Support Care Cancer (2004) 12:95–98 DOI 10.1007/s00520-003-0519-8 ORIGINAL ARTICLE Sebastiano Mercadante Flavio Fusco Alessandro Valle Fabio Fulfaro Alessandra Casuccio Stefania Silvestro Emanuela Donelli Factors involved in gastrointestinal bleeding in advanced cancer patients followed at home Received: 6 February 2003 Accepted: 8 July 2003 Published online: 12 December 2003  Springer-Verlag 2003 S. Mercadante ( ) ) Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Via S.Lorenzo 312, 90145 Palermo, Italy e-mail: terapiadeldolore@la-maddalena.it Tel.: +39-091-680652 Fax: +39-091-6806906 F. Fusco · S. Silvestro · E. Donelli Home Care Program, ASL 3, Genua, Italy A. Valle Fondazione FARO, Turin, Italy F. Fulfaro Department of Oncology, University of Palermo, Palermo, Italy A. Casuccio Department of Hygiene and Microbiology, University of Palermo, Palermo, Italy Abstract There is a lack of infor- mation on the frequency of symp- tomatic gastrointestinal bleeding in patients with advanced cancer. This group of patients presents several risk factors for developing gastrointestinal bleeding. The aim of this multicenter longitudinal survey was to assess the frequency of gastrointestinal bleeding and possible factors implicated in advanced cancer patients followed at home. A consecutive sample of 439 patients who referred to home pal- liative care program entered the study. Age, gender, primary cancer and known metastases, possible as- sociated pathologies, history of peptic disease, use of previous or actual nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids, drugs used to prevent gastric complications, the occurrence of hematemesis or mel- ena, significant anemia requiring blood transfusion, and mortality as- sociated with the hemorrhagic event were recorded. Of 377 patients who completed the study, 18 reported gastrointestinal bleeding, and five had significant anemia requiring blood transfusion in three cases. Death was found to be related to bleeding in three patients. NSAIDs, steroids, and gastroprotectors were frequently used, either before or during home care. However, no clear relationship between age, gender, and the use of offender drugs with gas- trointestinal bleeding was found. Liver involvement was frequently associated with the risk of developing gastrointestinal bleeding. Keywords Gastrointestinal bleeding · Complications · Cancer · NSAIDs · Steroids · Multicenter epidemiologic study Introduction There is a lack of information on the frequency of symptomatic gastrointestinal bleeding in patients with advanced cancer. It may occur as a result of tumor involvement of the gastrointestinal tract, or a reactivation of preexisting gastrointestinal lesions induced by drugs often used in the palliative setting. In a previous survey, the incidence of hemorrhagic events was associated with hepatic involvement—primary tumor or liver metastas- es—likely due to thrombocytopenia and coagulation factor deficiencies or secondary esophageal varices [1]. However, the use of drugs possibly inducing gastro- intestinal mucosal damage or other important factors implicated in inducing gastrointestinal bleeding were not taken into consideration in the entire population for comparison. Moreover, data were pooled from a same team, which may have influenced the results, by using specific protocols or approaches. The aim of this study was to assess the incidence of gastrointestinal bleeding, and its consequences and possible associated factors in