The Consequences of Diarrhea Occurring During Chemotherapy for Colorectal Cancer: A Retrospective Study

Abstract

Purpose. Diarrhea is one of the dose-limiting toxicities associated with chemotherapy agents in treatment regimens for colorectal cancer. The objectives of this study were to analyze the impact of all grades of diarrhea on clinical decisions for patients receiving treatment for colorectal cancer by characterizing the diarrhea that occurred, quantifying changes in chemotherapy treatment, identifying methods to treat diarrhea, and determining the economic impact.Patients and Methods. We retrospectively reviewed the treatment of 100 consecutive patients with colorectal cancer who experienced diarrhea during the course of chemotherapy. The diarrhea was documented in the progress notes and graded according to National Cancer Institute Common Toxicity Criteria. Changes in chemotherapy treatment and resource utilization associated with diarrhea were recorded.Results. The 100 patients received 673 chemotherapy cycles, of which 45% ± 2% were associated with diarrhea. Approximately 52% of patients experienced diarrhea of grades 3 or 4, and 56 patients underwent 66 modifications in their chemotherapy treatment, such as dose reductions (22), delays in therapy (8), discontinuations of therapy (15), or multiple changes (11). Thirtyseven patients consumed resources beyond oral antidiarrheals to control diarrhea: 14 patients received emergency outpatient treatment, 23 patients were hospitalized, 21 patients received intravenous fluids, and one death due to dehydration was reported.Discussion and Conclusion. Diarrhea was a significant consequence of colorectal chemotherapy, with the majority of patients experiencing grades 3 or 4 diarrhea and 56% of all patients also modifying their chemotherapy treatment. Even mild diarrhea of grades 1 and 2 was associated with changes in treatment in 11% of patients; thus, diarrhea of all grades should be recognized and treated appropriately to maintain full-dose chemotherapy.

Safety Profile and Clinical Recommendations for the Use of Lapatinib

“…2. Management algorithm for lapatinibassociated diarrhea for physicians developed by the author and C. Jackisch from [9][10][11][12][13][14]. eruption becomes manifest, followed by crusting at week 4.…”

The Role of Supportive Therapy in the Era of Modern Adjuvant Treatment – Current and Future Tools

“…Fluid and electrolyte loss may result in dehydration and ultimately renal insufficiency, also the rate of infectious complications is increased [46]. Furthermore, as with other serious side effects, chemotherapy-induced diarrhoea may lead to dose reductions and treatment delays, thereby impairing activity of anti-cancer treatment [64]. The combination of irinotecan and 5-FU may pose a special threat for developing diarrhoea, and is associated with an increased risk of treatment-related mortality [65,66].…”

Resolution of refractory chemotherapy-induced diarrhea (CID) with octreotide long-acting formulation in cancer patients: 11 case studies

“…Selection of an antidiarrheal treatment is influenced by diarrhea severity, ease of administration, and cost [1]. The primary goals of therapy are to: reduce the pain and discomfort associated with excessive bowel movements; eliminate the need for oral or intravenous rehydration, electrolyte replacement, and hospitalization; support patient compliance with the therapeutic regimen; and permit continuation of the prescribed chemotherapeutic regimen [4].…”

“…These alterations from optimal chemotherapy can have an adverse impact on treatment outcomes. Furthermore, the psychosocial aspects of coping with treatment-related diarrhea, as well as the difficulty in overcoming malnutrition and fatigue associated with both disease and treatment, can lead to decreased patient compliance, decreased self-esteem, decreased QOL, and even refusal of further therapy [1]. Therapeutic outcomes are thereby adversely affected.…”

“…In a retrospective study of 100 patients with colorectal cancer , 52% of patients experienced severe diarrhea and 56% experienced chemotherapy dose reduction, therapy delay or discontinuation, or multiple therapeutic changes [1]. Fourteen percent of patients required emergency outpatient treatment, 23% were hospitalized, and 21% received intravenous fluids.…”