Presentation is loading. Please wait.

Presentation is loading. Please wait.

DIARRHOEA Dr Eliyaz Ahmed and Dr Sarah Smith MDSC156: Acute Clinical Oncology POSTGRADUATE SCHOOL OF MEDICINE A MEMBER OF THE RUSSELL GROUP CONTINUING.

Similar presentations


Presentation on theme: "DIARRHOEA Dr Eliyaz Ahmed and Dr Sarah Smith MDSC156: Acute Clinical Oncology POSTGRADUATE SCHOOL OF MEDICINE A MEMBER OF THE RUSSELL GROUP CONTINUING."— Presentation transcript:

1 DIARRHOEA Dr Eliyaz Ahmed and Dr Sarah Smith MDSC156: Acute Clinical Oncology POSTGRADUATE SCHOOL OF MEDICINE A MEMBER OF THE RUSSELL GROUP CONTINUING PROFESSIONAL DEVELOPMENT

2 2 Diarrhoea Diarrhoea is a common toxicity of systemic anticancer treatment Can be quite debilitating with volume depletion, electrolyte disturbances and risk of renal failure Can interfere with treatment of malignancy due to dose delays and reductions and increased hospitalisation Assessment is crucial in decision on out-patient vs. in-patient management

3 3 Diarrhoea Chemotherapy Induced Diarrhoea Chemotherapy Induced Diarrhoea (CID) can include drugs such as capecitabine, cisplatin, cyclophosphamide, daunorubicin, doxorubicin, docetaxel, methotrexate, oxaliplatin, and paclitaxel. Incidence can be as high as % with drugs such as Irinotecan and 5-Flurouracil/Capecitabine Targeted therapies such as, erlotinib, sorafenib, and cetuximab, may also cause significant CID.

4 4 Diarrhoea Aetiology of Diarrhoea in Cancer Patients Treatment related: Chemotherapy and targeted agents-most common drugs associated with diarrhoea are 5- fluorouracil/Capecitabine and Irinotecan,Erlotinib, Gefitinib, Sorafenib, Lapatinib and Cetuximab BMT Pelvic and abdominal radiotherapy Disease related: Neuroendocrine cancers, islet cell tumours, Biliary obstruction Surgery of GI tract Whipples, intestinal resection (short bowel) Drugs: Antibiotics, laxatives, iron etc Infections : Bacterial (clostridium difficile), fungal Dietary factors : High fibre, lactose products, laxatives

5 5 Diarrhoea Assessment History and examination Vital signs, skin turgor Biochemistry, stool culture Complicated vs. uncomplicated Complicated diarrhoea Grade 3 and 4 Grade 1 or 2 associated with one or more of the following: nausea/vomiting, Fever and neutropenia, sepsis, bleeding, dehydration, moderate to severe abdominal cramping, declining performance status Uncomplicated Grade 1 and 2

6 6 Diarrhoea Grade Description 1Increase of <4 stools/day over baseline; mild increase in ostomy output compared with baseline 2Increase of 4–6 stools/day over baseline; moderate increase in ostomy output compared with baseline 3Increase of ≥7 stools/day over baseline; incontinence; hospitalization indicated; severe increase in ostomy output compared with baseline; limiting self-care ADL 4Life-threatening consequences; urgent intervention indicated 5Death Grading of Diarrhoea National Cancer Institute’s Common Toxicity criteria version 4.0

7 7 Diarrhoea

8 8

9 9 Management Patient education Diet Increased fluid intake ( up to 3 L/day) Low fibre diet, avoid milk and dairy products and caffeine containing drinks etc. Antidiarrhoeals Antimotility agents: Loperamide 4 mg, followed by 2 mg after each unformed stool with a maximum of 16 mg/day Stop chemotherapy/biologicals until complete resolution of symptoms

10 10 Diarrhoea Management Complicated diarrhoea Hydration: IV fluids and electrolyte replacement Treat Sepsis Octroeotide : Starting dose of 100 to 150 ug SC tid or IV (25 to 50g/h) and consider increasing dose if diarrhoea is persistent

11 11 Diarrhoea Management of Diarrhoea

12 12 Diarrhoea Further reading ons/HealthProfessional/page5 ons/HealthProfessional/page5 Richardson & Dobish, 2007 Arnold RJ, Gabrail N, Raut M, et al.: Clinical implications of chemotherapy-induced diarrhoea in patients with cancer. J Support Oncol 3 (3): , 2005 May-Jun Zidan J, Haim N, Beny A, et al.: Octreotide in the treatment of severe chemotherapy-induced diarrhea. Ann Oncol 12 (2): 227-9, Benson AB III., Ajani JA, Catalano RB, et al.Recommended Guidelines for the Treatment of Cancer Treatment-Induced Diarrhoea. J Clin Oncol 2004;22:

13 A MEMBER OF THE RUSSELL GROUP FACULTY OF HEALTH & LIFE SCIENCES – CPD Institute for Learning & Teaching Faculty of Health & Life Sciences Room 2.16A, 4th Floor Thompson Yates Building Brownlow Hill Liverpool L69 3GB


Download ppt "DIARRHOEA Dr Eliyaz Ahmed and Dr Sarah Smith MDSC156: Acute Clinical Oncology POSTGRADUATE SCHOOL OF MEDICINE A MEMBER OF THE RUSSELL GROUP CONTINUING."

Similar presentations


Ads by Google