Maroun, J.A., Anthony, L.B., Blais, N., Burkes, R., Dowden, S.D., Dranitsaris, G., . . . Wong, R. (2007). Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: A consensus statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea. Current Oncology, 14, 12–20.   

DOI Link

Purpose & Patient Population

PURPOSE: To review the optimal approach for managing chemotherapy-induced diarrhea (CID) and expand on guidelines previously developed by Cancer Care Ontario
 
TYPES OF PATIENTS ADDRESSED: Patients receiving chemotherapy for colorectal cancer

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline  

PROCESS OF DEVELOPMENT: Review of selected literature and retrospective review of 63 patients hospitalized for CID

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results Provided in the Reference

No specific broad search and literature review were used. A few study findings are cited. No information was provided regarding the strength of evidence cited.

Guidelines & Recommendations

  • Recommends CID severity grading using the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)
  • Notes the lack of and need for information identifying risk factors and development of a predictive model for CID severity
  • Outlines methods for patient evaluation of possible causes of diarrhea and workup to include complete and differential blood count, blood chemistry, and stool analysis
  • Recommends dietary management eliminating caffeine, alcohol, lactose, and high-fat foods
  • Identifies loperamide or high-dose loperamide as first-line treatment, octreotide for intractable grade 1 or 2 diarrhea, and fluid/electrolyte replacement for grade 3 or 4 diarrhea
  • Recommends consideration of long-acting octreotide for patients who had grade 3 or 4 diarrhea in a previous chemotherapy cycle as prophylaxis

Limitations

  • Mainly consensus-based guideline

Nursing Implications

Algorithm and consensus recommendations are provided for management of CID. Although these guidelines are aimed specifically at colorectal cancer cases, principles are likely to apply to other tumor types. Whether the mechanisms of diarrhea, and, therefore, effective treatments, are the same with various chemotherapy agents is unclear, and research is limited in this area. Prophylactic use of octreotide is suggested for patients who had diarrhea in a previous cycle of treatment in order to attempt to avoid the need for dose reductions or treatment delays.