Introduction Better cancer treatments have led to enormous improvements in the outcomes for these patients with the result that the overall number of survivors of cancer therapy continues to grow. However, after cancer treatment, up to 50% patients are left with diarrhoea - the most prevalent symptom. Causes are likely to encompass several contributing GI diagnoses.
Methods A service evaluation was conducted of new patients attending our clinic, reporting diarrhoea after treatment for cancer. All patients attending the clinic completed a patient recorded outcome measure describing their symptoms and a Bristol Stool Chart describing stool type. They were investigated using a peer reviewed investigational and management algorithm. Patient characteristics, symptom incidence and severity were recorded prospectively.
Results Over a 6 month period (July - Dec 2012), 207 patients were newly referred to the GIANTs. Of those, 104 (50%) reported diarrhoea (type 6 or 7 Bristol Stool Chart). In this group there were slightly more men (52%) than women (48%). Their median age was 62 years (range: 22–89). Primary tumour sites included urological cancer (34% - 82% of these prostate), gynaecological (22%), colorectal (20%), upper GI (10%), haematological (8%), and other (6%). 69% had undergone pelvic radiotherapy, 48% had been treated with surgery or received chemotherapy. 12% received pelvic radiotherapy alone, 6% surgery and 3% chemotherapy alone. Over a quarter (29%) received all 3 treatment modalities.
Small intestinal bacterial overgrowth was found in 49%. Bile acid malabsorption was newly diagnosed in 33% of patients. Weak pelvic floor musculature was a contributing factor in 20%. 13% were diagnosed with new pancreatic insufficiency. Excess fibre intake (>20g/day) was a contributory factor in 11% and Lansoprazole in up to 9% of patients. Other factors included: thyroid problems (9%), anal fissure (5%), rectal ulceration (5%), faecal loading (5%) and new onset Inflammatory Bowel Disease (3%). A colorectal polyp was found in 16% of patients, 1 patient had a new colorectal cancer and 2 had a GI stricture.
80% of patients had multiple causes for their diarrhoea. Most patients were discharged with a significant improvement in their symptoms with a median of 4 consultations (range 1–7) after systematic assessment and targeted management of the causes for their symptoms.
Conclusion Diarrhoea after cancer treatment is frequent in the patient cohort seen in our clinic. Several GI causes contribute to diarrhoea simultaneously in most patients but the majority can be discharged after a small number of consultations with a significant improvement or full resolution of their symptom if a systematic investigational and treatment approach is adopted.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.