Guidance on the management of diarrhoea during cancer chemotherapy

Jervoise Andreyev, Paul Ross, Clare Donellan, Elaine Lennan, Pauline Leonard, Caroline Waters, Linda Wedlake, John Bridgewater, Rob Glynne-Jones, William Allum, Ian Chau, Richard Wilson, David Ferry

Research output: Contribution to journalLiterature review

67 Citations (Scopus)

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.
Original languageEnglish
Pages (from-to)e447–e460
Number of pages14
JournalLancet Oncology
Volume15
Issue number10
DOIs
Publication statusPublished - Sep 2014

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Diarrhea
Drug Therapy
Neoplasms
Loperamide
Morbidity
Octreotide
Nutritionists
Mortality
Poisons
Patient Education
Pharmacists
Resuscitation
Caregivers
Randomized Controlled Trials
Nurses
Guidelines
Therapeutics
Research
Oncologists

Cite this

Andreyev, J., Ross, P., Donellan, C., Lennan, E., Leonard, P., Waters, C., ... Ferry, D. (2014). Guidance on the management of diarrhoea during cancer chemotherapy. Lancet Oncology, 15(10), e447–e460. https://doi.org/10.1016/S1470-2045(14)70006-3
Andreyev, Jervoise ; Ross, Paul ; Donellan, Clare ; Lennan, Elaine ; Leonard, Pauline ; Waters, Caroline ; Wedlake, Linda ; Bridgewater, John ; Glynne-Jones, Rob ; Allum, William ; Chau, Ian ; Wilson, Richard ; Ferry, David. / Guidance on the management of diarrhoea during cancer chemotherapy. In: Lancet Oncology. 2014 ; Vol. 15, No. 10. pp. e447–e460.
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Andreyev, J, Ross, P, Donellan, C, Lennan, E, Leonard, P, Waters, C, Wedlake, L, Bridgewater, J, Glynne-Jones, R, Allum, W, Chau, I, Wilson, R & Ferry, D 2014, 'Guidance on the management of diarrhoea during cancer chemotherapy', Lancet Oncology, vol. 15, no. 10, pp. e447–e460. https://doi.org/10.1016/S1470-2045(14)70006-3

Guidance on the management of diarrhoea during cancer chemotherapy. / Andreyev, Jervoise; Ross, Paul; Donellan, Clare; Lennan, Elaine; Leonard, Pauline; Waters, Caroline; Wedlake, Linda; Bridgewater, John; Glynne-Jones, Rob; Allum, William; Chau, Ian; Wilson, Richard; Ferry, David.

In: Lancet Oncology, Vol. 15, No. 10, 09.2014, p. e447–e460.

Research output: Contribution to journalLiterature review

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T1 - Guidance on the management of diarrhoea during cancer chemotherapy

AU - Andreyev, Jervoise

AU - Ross, Paul

AU - Donellan, Clare

AU - Lennan, Elaine

AU - Leonard, Pauline

AU - Waters, Caroline

AU - Wedlake, Linda

AU - Bridgewater, John

AU - Glynne-Jones, Rob

AU - Allum, William

AU - Chau, Ian

AU - Wilson, Richard

AU - Ferry, David

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AB - 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.

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DO - 10.1016/S1470-2045(14)70006-3

M3 - Literature review

VL - 15

SP - e447–e460

JO - Lancet Oncology

JF - Lancet Oncology

SN - 1470-2045

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Andreyev J, Ross P, Donellan C, Lennan E, Leonard P, Waters C et al. Guidance on the management of diarrhoea during cancer chemotherapy. Lancet Oncology. 2014 Sep;15(10):e447–e460. https://doi.org/10.1016/S1470-2045(14)70006-3