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Hospitalization, aggressive treatment, and vigilant monitoring, including complete blood counts, electrolyte assessment, and stool evaluations for blood, fecal leukocytes, and bacterial cultures, are indicated for patients with severe diarrhea.1 Treatment includes IV hydration, octreotide (100 to 150 mcg 3 times daily) and antibiotic therapy.1,3
Chronic radiotherapy-associated diarrhea can be treated with antidiarrheal medications unless contraindicated by symptoms of bowel obstruction; support for hyperbaric oxygen therapy remains anecdotal.3
PREVENTIVE MEASURES
Octreotide and sucralfate (Carafate, generics) are not indicated as a diarrheal prophylactic or preventive for radio-
therapy patients.6,9 A phase 3, double- blind clinical trial of prophylactic octreotide to prevent diarrhea among patients undergoing pelvic radiotherapy found no benefit over placebo, and found that some GI symptoms, including patient-reported nocturnal bowel movements and bloody stool were more frequent among patients receiving octreotide.9
In contrast, probiotics (orally administered live gut bacteria) might prevent radiotherapy-associated diarrhea, administered alone starting on day 1 of pelvic or abdominal radiotherapy or with psyllium fiber (1 to 2 teaspoons daily), which absorbs intestinal fluids.1,8 Strain VSL#3 (VSL Pharmaceuticals, Inc.) administered daily through radiotherapy is associated with significantly reduced bowel movements and diarrhea incidence among patients receiving pelvic radiotherapy who had undergone surgical resection of colorectal and cervical cancers.8 Lactobacillus acidophilus NDCO 1748 is also associated with significant reductions in pelvic radiotherapy-associated diarrhea.8
The Oncology Nursing Society evidence-based guidelines for managing radiotherapy-related diarrhea indicate selenium (Selsun, generics), sulfasalazine (Azulfidine, generics), and pentosan polysulfate (Elmiron) are unlikely to benefit patients with radiotherapy-associated diarrhea.1,6 ONA
Bryant Furlow is a medical journalist based in Albuquerque, New Mexico.
REFERENCES
1. Shaw C, Taylor L. Treatment-related diarrhea in patients with cancer. Clin J Oncol Nurs. 2012;16(4):413-417.
2. Anthony LB. Diarrhea, constipation, and obstruction in cancer management. In: Olver IN (ed), The MASCC Textbook of Cancer Supportive Care and Survivorship. Berlin, Germany: Springer-Verlag; 2011:249-260.
3. Cherny NI. Evaluation and management of treatment-related diarrhea in patients with advanced cancer: a review. J Pain Symptom Manage. 2008;36(4):413-423.
4. Hautmann MG, Hipp M, Kölbl O. Clostridium difficile-associated diarrhea in radiooncology: an underestimated problem for the feasibility of the radiooncological treatment? Radiat Oncol. 2011;6:89-96.
5. US National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Bethesda, MD; 2010. http:// www.eortc.be/services/doc/ctc/CTCAE_ 4.03_2010-06-14_QuickReference_5x7.pdf. Accessed January 27, 2013.
6. Oncology Nursing Society. Preventing and Treating Diarrhea Related to Chemotherapy and/or Radiation Therapy: Systematic Review/Meta-analysis Table. http://www.ons.org/Research/PEP/media/ons/docs/research/outcomes/diarrhea/review-table.pdf. Accessed January 27, 2013.
7. National Cancer Institute. Gastrointestinal complications (PDQ). http://www.cancer.gov/cancertopics/pdq/supportivecare/gastrointestinalcomplications/HealthProfessional/page5/AllPages/Print. Accessed January 27, 2013.
8. Muehlbauer PM, Thorpe D, Davis A, et al. Putting evidence into practice: evidence-based interventions to prevent, manage and treat chemotherapy- and radiotherapy-induced diarrhea. Clin J Oncol Nurs. 2009;13(3):336-341.
9. Martenson JA, Halyard MY, Sloan JA, et al. Phase III, double-blind study of depot octreotide versus placebo in the prevention of acute diarrhea in patients receiving pelvic radiation therapy: results of North Central Cancer Treatment Group N00CA. J Clin Oncol. 2008;26(32):5248-5253.
