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Lancet Oncol. 2014 Sep;15(10):e447-60. doi: 10.1016/S1470-2045(14)70006-3.

Guidance on the management of diarrhoea during cancer chemotherapy.

Author information

1
Gastrointestinal Unit, Royal Marsden NHS Foundation Trust London and Surrey, London, UK. Electronic address: J@andreyev.demon.co.uk.
2
Cancer Services, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
3
Gastrointestinal and Liver Services, Leeds Teaching Hospital NHS Trust, Leeds, UK.
4
University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
5
Medical Oncology, Whittington Hospital NHS Trust, London, UK.
6
Pharmacy, Kent and Medway Cancer Network, Chatham, Kent, UK.
7
Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
8
Cancer Services, University College Hospital, London, UK.
9
Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
10
Department of Surgery, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
11
Department of Medicine, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
12
Northern Ireland Cancer Trials Network, Belfast City Hospital, Belfast, UK.
13
Department of Oncology, New Cross Hospital, Wolverhampton, UK.

Abstract

Diarrhoea induced by chemotherapy in cancer patients is common, causes notable morbidity and mortality, and is managed inconsistently. Previous management guidelines were based on poor evidence and neglect physiological causes of chemotherapy-induced diarrhoea. In the absence of level 1 evidence from randomised controlled trials, we developed practical guidance for clinicians based on a literature review by a multidisciplinary team of clinical oncologists, dietitians, gastroenterologists, medical oncologists, nurses, pharmacist, and a surgeon. Education of patients and their carers about the risks associated with, and management of, chemotherapy-induced diarrhoea is the foundation for optimum treatment of toxic effects. Adequate--and, if necessary, repeated--assessment, appropriate use of loperamide, and knowledge of fluid resuscitation requirements of affected patients is the second crucial step. Use of octreotide and seeking specialist advice early for patients who do not respond to treatment will reduce morbidity and mortality. In view of the burden of chemotherapy-induced diarrhoea, appropriate multidisciplinary research to assess meaningful endpoints is urgently required.

PMID:
25186048
DOI:
10.1016/S1470-2045(14)70006-3
[Indexed for MEDLINE]

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