Gastrointestinal symptoms in cancer patients with advanced disease:  new methodologies, insights, and a proposed approach.
OBJECTIVE
This review summarizes recent developments in the management of gastrointestinal symptoms experienced by cancer patients and provides a framework for 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. Current clinical guidelines now recommend that patients treated with moderate emetic risk chemotherapy regimens be preferentially treated with the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, palonosetron, in combination with dexamethasone. A large randomized trial has also recently validated that single-dose fosaprepitant is equivalent to the standard 3-day, aprepitant regimen. New medications, such as skin patch delivery of granisetron for nausea or methylnaltrexone for constipation, show promise in both the management of symptoms and as preventive agents. The integration of complementary and alternative therapies, such as relaxation techniques, ginger, 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 disproportionate with objective measures. New methodologies that harness technology to collect patient-reported outcomes may improve the accuracy of assessment, provide a better picture of the patient's experience of gastrointestinal symptoms, and deliver 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. When combined with refinements in the overall clinical approach to symptom management, standardized instruments that streamline data collection and enable data warehousing will support better symptom management.
Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA.
Fatima
F
Rangwala
S Yousef
SY
Zafar
Amy P
AP
Abernethy
D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D003907:Dexamethasone / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D020939:Zingiber officinale; D017829:Granisetron / Q000627:therapeutic use; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D009325:Nausea / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D010166:Palliative Care; D000077924:Palonosetron; D011812:Quinuclidines / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000627:therapeutic use; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
D000932:Antiemetics; D000970:Antineoplastic Agents; D003907:Dexamethasone; D017829:Granisetron; D007546:Isoquinolines; D000077924:Palonosetron; D011812:Quinuclidines; D012702:Serotonin Antagonists