Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposed approach.
OBJECTIVE
This review summarizes recent developments in the palliative management of gastrointestinal symptoms experienced by advanced cancer patients and provides a framework for detailing that encompasses education, assessment and monitoring, and treatment.


RESULTS
Although many viable treatment options exist, gastrointestinal symptoms, particularly nausea and vomiting, constipation, and diarrhea, continue to challenge both patients and clinicians. New medications, such as skin patch delivery of granisetron for nausea or methylnaltrexone for constipation, show promise of better symptom management, and are advancing alongside an increasing emphasis on prevention. The integration into care plans of complementary and alternative therapies, such as relaxation techniques and electroacupuncture, may also assist with symptom relief. Accurate assessment is essential but often problematic, especially as the patient's experience of gastrointestinal distress is often incommensurate with objective measures. New methodologies that harness technology to collect patient-reported outcomes may improve the accuracy of assessment, better capture the patient's experience of gastrointestinal symptoms, and provide a means to simultaneously monitor symptoms, educate patients, and collect longitudinal data.


CONCLUSIONS
Palliative management of gastrointestinal symptoms in advanced cancer patients requires a multipronged approach that entails effective assessment, judicious use of latest evidence-based approaches, and monitoring that incorporates both clinical measures and patient-reported outcomes. In combination with refinements in the overall clinical approach to symptom management, the deployment of standardized instruments that streamline data collection and enable data warehousing will support better symptom management.
Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. amy.abernethy@duke.edu
Amy P
AP
Abernethy
Jane L
JL
Wheeler
S Yousuf
SY
Zafar
D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D009325:Nausea / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D009369:Neoplasms / Q000150:complications*; D012720:Severity of Illness Index