title: Guidance on the management of diarrhoea during cancer chemotherapy.
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.
authors.affiliation: Gastrointestinal Unit, Royal Marsden NHS Foundation Trust London and Surrey, London, UK. Electronic address: J@andreyev.demon.co.uk.
authors.forename: Jervoise
authors.initials: J
authors.lastname: Andreyev
authors.affiliation: Cancer Services, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Ross
authors.affiliation: Gastrointestinal and Liver Services, Leeds Teaching Hospital NHS Trust, Leeds, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Donnellan
authors.affiliation: University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Lennan
authors.affiliation: Medical Oncology, Whittington Hospital NHS Trust, London, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Leonard
authors.affiliation: Pharmacy, Kent and Medway Cancer Network, Chatham, Kent, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Waters
authors.affiliation: Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Wedlake
authors.affiliation: Cancer Services, University College Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Bridgewater
authors.affiliation: Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Glynne-Jones
authors.affiliation: Department of Surgery, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
authors.forename: William
authors.initials: W
authors.lastname: Allum
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust London and Surrey, London, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
authors.affiliation: Northern Ireland Cancer Trials Network, Belfast City Hospital, Belfast, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Wilson
authors.affiliation: Department of Oncology, New Cross Hospital, Wolverhampton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Ferry
mesh_terms: D000930:Antidiarrheals / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003967:Diarrhea / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000930:Antidiarrheals; D000970:Antineoplastic Agents