A randomised phase IIb trial to assess the efficacy of ReCharge ice cream in preventing chemotherapy-induced diarrhoea

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.

Colostrum Proteins in Protection against Therapy-Induced Injuries in Cancer Chemo- and Radiotherapy: A Comprehensive Review

In this article, we review the benefits of application of colostrum and colostrum-derived proteins in animal models and clinical trials that include chemotherapy with antimetabolic drugs, radiotherapy and surgical interventions. A majority of the reported investigations was performed with bovine colostrum (BC) and native bovine or recombinant human lactoferrin (LF), applied alone, in nutraceutics or in combination with probiotics. Apart from reducing side effects of the applied therapeutics, radiation and surgical procedures, BC and LF augmented their efficacy and improved the wellness of patients. In conclusion, colostrum and colostrum proteins, preferably administered with probiotic bacteria, are highly recommended for inclusion to therapeutic protocols in cancer chemo- and radiotherapy as well as during the surgical treatment of cancer patients.

Effect of a dietary supplement composed of hydrolyzed milk proteins and vanillin on the reduction of infection and oxidative stress induced by chemotherapy

This study evaluates the antioxidant and antibacterial activity of a mixture of lactoferrin hydrolysate (LfH), whey protein hydrolysate (WPH) and vanillin in vitro and in vivo to design a chemoprotective supplement for reducing the infection and oxidative stress induced by chemotherapy. The designed supplement showed significant antibacterial activity against E. coli. The supplement with the highest concentration exhibited considerable antioxidant activity in (2,2-diphenyl-1-picrylhydrazyl) DPPH free radicals, (2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) ABTS, and reducing power assays. In the biochemical analysis of liver homogenate, the supplement 3 increased the level of enzymes Catalase (CAT), Glutathione peroxidase (GPx), Superoxide dismutase (SOD), and also the Ferric Reducing Ability of Plasma (FRAP) while decreased thiobarbituric acid reactive substances (TBARS) in comparison to paclitaxel group, indicative of activity against oxidative stress. Antibacterial and antioxidant activity of the designed supplement makes it a good candidate for use as a functional food to reduce the side effects of chemotherapy. PRACTICAL APPLICATIONS: A dietary supplement composed of lactoferrin hydrolysate (LfH), whey protein hydrolysate (WPH) and vanillin showed antibacterial activity against E. coli and S. aureus in vitro. The studied supplement also exhibited significant antioxidant properties in the model system and anti-oxidative stress activity in mice exposed to paclitaxel. This supplement has a potential for use in the food matrix to reduce the chemotherapy side effects and to act as a chemoprotective agent.

The development and initial evaluation of the Diarrhoea Management Diary (DMD) in patients with metastatic breast cancer

PURPOSE

Chemotherapy-induced diarrhoea (CID) is a common, but often underreported problem in patients with breast cancer that has a profound effect on quality of life. It is best measured from a patient's perspective, but tools are limited. The aim of this study was to develop and evaluate the Diarrhoea Management Diary (DMD), a self-report measure to assess CID, use of self-management strategies and treatment adherence.

METHODS

The DMD was constructed using an iterative process of instrument development: concept elicitation (literature review), item generation and reduction (cognitive debriefing), and pilot testing in the target population. After translation into eight languages, the DMD was used in an international randomised trial for women receiving lapatinib and capecitabine for metastatic breast cancer with or without prophylactic octreotide. Patterns of missing data and sensitivity to change were examined.

RESULTS

The understandability and completeness of the 8-item DMD was confirmed in cognitive interviews and pilot testing. Practicability of the DMD was evaluated in 62 women with metastatic breast cancer (median age 57). Up to 68% reported CID at any given time-point, and 19% had diarrhoea at each time-point. Patients also described efficacy of different strategies for diarrhoea management. Missing data were associated with study discontinuation. DMD missing item response was 0.9%. Sensitivity to change was good at most assessment points.

CONCLUSIONS

Although further psychometric testing is recommended, initial evaluation of the DMD showed good content validity and practicability in international research with cancer patients.

Role of clinical oncology pharmacist in determination of pharmaceutical care needs in patients with colorectal cancer

OBJECTIVE

To determine and evaluate the pharmaceutical care needs and quality of life of patients with colorectal cancer.

METHODS

36 Patients with colorectal cancer eligible for chemotherapy after surgery were included in the study. The patients were followed up during 3 courses of chemotherapy and individual pharmaceutical care plans were developed. The quality of life of patients was evaluated before and after the third course of chemotherapy.

RESULTS

The incidence of drug-related problems (DRPs) in chemotherapy-treated patients was reduced in the 3rd course as compared with 1st course (63.9% vs 75%, respectively; n=36; p>0.05). The clinical oncology pharmacist gave 147 recommendations to patients, which were followed in 98% (n=144) of cases. 91.7% (n=132) of the recommendations of clinical oncology pharmacists solved the drug-related problems; however, the remaining 8.3% (n=12) did not solve the problems and the patients were referred to a doctor for further investigations. The symptom-related quality of life of patients related to anaemia, diarrhoea and neurotoxicity was reduced after the third course of chemotherapy (p<0.05).

CONCLUSIONS

The pharmaceutical care provided by the clinical oncology pharmacist has an important role in the identification and resolution of DRPs. Evaluation of symptom-related quality of life is important for the monitoring of patients receiving chemotherapy.

Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.