Recommended Guidelines for the Treatment of Cancer Treatment-Induced Diarrhea

Author:

Benson Al B.1,Ajani Jaffer A.1,Catalano Robert B.1,Engelking Constance1,Kornblau Steven M.1,Martenson James A.1,McCallum Richard1,Mitchell Edith P.1,O'Dorisio Thomas M.1,Vokes Everett E.1,Wadler Scott1

Affiliation:

1. From the Northwestern University Feinberg School of Medicine; University of Chicago Medical Center, Chicago, IL; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Coalition of National Cancer Cooperative Groups, Inc; Thomas Jefferson University, Philadelphia, PA; Arlin Cancer Institute, Westchester Medical Center, Valhalla; Weill Medical College of Cornell University, New York, NY; Mayo Clinic, Rochester, MN; The University of Kansas Medical Center, Kansas City, KS; and University of Iowa...

Abstract

PurposeTo update and expand on previously published clinical practice guidelines for the treatment of cancer treatment-induced diarrhea.MethodsAn expert multidisciplinary panel was convened to review the recent literature and discuss recommendations for updating the practice guidelines previously published by this group in the Journal of Clinical Oncology in 1998. MEDLINE searches were performed and the relevant literature published since 1998 was reviewed by all panel members. The treatment recommendations and algorithm were revised by panel consensus.ResultsA recent review of early toxic deaths occurring in two National Cancer Institute-sponsored cooperative group trials of irinotecan plus high-dose fluorouracil and leucovorin for advanced colorectal cancer has led to the recognition of a life-threatening gastrointestinal syndrome and highlighted the need for vigilant monitoring and aggressive therapy for this serious complication. Loperamide remains the standard therapy for uncomplicated cases. However, the revised guidelines reflect the need for recognition of the early warning signs of complicated cases of diarrhea and the need for early and aggressive management, including the addition of antibiotics. Management of radiation-induced diarrhea is similar but may not require hospitalization, and chronic low- to intermediate-grade symptoms can be managed with continued loperamide.ConclusionWith vigilant monitoring and aggressive therapy for cancer treatment-induced diarrhea, particularly in patients with early warning signs of severe complications, morbidity and mortality may be reduced.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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