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PTH-137 The Gi And Nutrition Team Service (giants): Managing Gi Consequences Of Cancer Treatment – Who? What? And How?
  1. A Muls,
  2. J Andreyev
  1. GI Unit, Royal Marsden NHS Foundation Trust, London, UK

Abstract

Introduction Our clinic specialising in gastrointestinal problems after cancer treatment, seems to be attracting patients with GI consequences resulting from a wider variety of cancer therapies. We present an analysis of new patients referred to our GI and Nutrition Team service.

Methods A service evaluation of new patients attending the clinic is ongoing after gaining appropriate approvals. All patients attending clinic complete a patient recorded outcome measure describing their symptoms, a Bristol Stool Chart describing stool type and a quality of life scale. Patients are investigated systematically depending on their symptoms, using a peer-reviewed algorithm. Patient characteristics, symptom incidence and severity are recorded prospectively.

Results Data for July-December 2012 were analysed. 207 patients were newly referred to the GIANTs. Their median age was 61.6 years (range: 22–89). 55% were male. The largest group were patients treated for a urological malignancy (37%), followed by those with a gynaecological (18%), colorectal (16%), upper GI cancer (12%), other cancers (8%), haematological malignancy (6%) and no previous cancer diagnosis (3%). 71% of patients had received pelvic radiotherapy, 3% chemotherapy, 11% GI surgery and 11% were treated with both chemotherapy and surgery. 4% had not yet received any cancer treatment and were usually referred to exclude the presence of IBD, a relative contra-indication to radiotherapy.

Comparing symptom profiles of patients who received pelvic radiotherapy (n = 140) and those treated with other treatment modalities (n = 61), reveals that most patients were troubled by multiple symptoms: urgency (62 vs. 52%), diarrhoea (57 vs. 51%), tenesmus (47 vs. 43%), flatulence (56 vs. 52%), borborygmi (36% vs 52%) abdominal pain (39% both groups), bloating (29 vs. 38%), faecal leakage (16 vs. 31%) and nocturnal defaecation (31% both groups). Rectal bleeding was reported by 34% of patients who received pelvic radiation, compared to 13% in the other group. Fatigue affected both groups (46 vs. 54%).

The types of diagnosis to account for the symptoms made in both groups were similar: small intestinal bacterial overgrowth (24% pelvic radiotherapy vs. 28% other cancer treatments). Bile acid malabsorption was diagnosed in 16% (both groups) and pancreatic insufficiency in 6 and 5%.

Conclusion Gastrointestinal problems after any cancer treatment are frequent and the symptom burden is high. The prevalence of symptoms patients describe after pelvic radiotherapy differs from those treated with other modalities but the causes identified for those symptoms are the same. A systematic management algorithm and multidisciplinary approach is required to manage those complex symptoms optimally.

Disclosure of Interest None Declared.

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