Interventions for reducing diarrhoea in patients receiving chemotherapy for colorectal cancer

Abstract

Globally, Colorectal cancer (CRC) affects more than one million people with nearly six hundred thousand deaths per year. At diagnosis, only 13,8% of the patients are in the stage I (TNM classification). However all patients with CRC will need chemotherapy, alone or in combination with surgery or radiotherapy. Chemotherapy for CRC usually affects the gastrointestinal tract, leading to toxicities like: increased gut motility with reduced transit time for bowel contents, reduced water and chloride absorption, causing diarrhoea. Diarrhoea induced by chemotherapy (DIC), changes the native microflora and affecting a number of gut function, including protection metabolism of bilirubin, mucins, pancreatic enzymes, fatty acids, bile acids, cholesterol steroid hormone and immune functions. When diarrhoea is associated to neutropenia, the impaired immune defence and the impaired of ephitelial permeability may promote the translocation of microflora, increasing the risk of infectious complications and gram negative sepsis. Another complication of DIC is electrolyte losses, life-threatening dehydration, electrolyte imbalances, renal insufficiency andnutritional deficiencies. DIC is a very common adverse event in the treatment of CRC, affecting almost all patients and it affect quality of life, modify the protocol of chemotherapy (change, delay or interrupt the chemotherapy) and increase mortality.The management of DIC involves a lot of different interventions that encompass changes in dietary regimens and the use of different pharmacological drugs. The pharmacologic interventions include different classes of drugs like: Opioids, Atropine, Somatostatin analogues, vasoactive intestinal peptide, gastrin, Antiinflammatory hormonal, no Absorble Antibiotics (e.g. Neomycin), Adsorbents that are agents that attract other materials or particles to its surface, Absorbents substances (Psyllium, methylcellulose and pectin), Amino acid (e.g. glutamine) and probiotics (viable microbial dietary supplement, e.g. lactobacillus). Objectives: The objective is to determine the effectiveness and safety of different interventions (pharmacological as well as nonpharmacological) to reduce diarrhoea in patients receiving chemotherapy for CRC. Methods: systematic review and meta-analysis of randomized controlled trial that have compared different intervention to reduce diarrhoea in patients with CRC receiving chemotherapy. (AU)