A malignant bowel obstruction (MBO) from recurrent or progressive gynecologic cancer is a terminal diagnosis that is associated with symptoms of pain and nausea, emotional distress, and significant cost to the healthcare system. Prioritizing patient needs in the form of emotional support and symptom control, rather than detracting from these needs with aggressive surgery, can optimize multiple outcomes at the time of an MBO diagnosis. In this context, gastrostomy tubes are the best option to help control nausea and vomiting and potentially allow patients to receive more chemotherapy, with less risk of side effects or complications. Gastrostomy tubes are also associated with lower cost than surgical interventions for MBO and less intensive care at the end of life, setting the stage for appropriate focus on quality of life.