An evaluation of in-patient management of refractory or severe chemotherapy-induced diarrhea.

Abstract

e13126 Background: Chemotherapy-induced diarrhea (CID) is a common complication of cancer treatment, which can result in significant morbidity and mortality. American and Canadian guidelines recommend octreotide as first-line treatment option for the management of refractory or severe CID. Methods: This was a retrospective study that evaluated the management of CID in hospitalized patients at VA North and Central Texas Health Care Systems. Patients were eligible for study if they were admitted to the hospital due to 5-FU or CPT-11 related diarrhea. Patients were required to have received chemotherapy within 30 days of hospital admission. Objectives of the study were to evaluate the adherence to the CID guideline recommendations and morbidity and mortality associated with the management of CID. Results: Total of 28 patients were identified eligible for the study with mean age of 66 years. Fifty-seven percent of the patients had late onset (> 24 hours after chemotherapy) diarrhea and 64% had loperamide prior to the hospital admission. In-patient only 1 (4%) of the patients received octreotide as first-line treatment for the management of refractory or severe CID. Intravenous fluid was administered to 25 (89%) and antibiotics to 8 (29%) of the patients. Twenty-three of 28 (82%) patients achieved complete response (CR). Median time to complete resolution of diarrhea was 4 days and the mean length of hospital stay was 6.3 days. At 30 days from hospital admission overall mortality rate was 11%. Patients who achieved CR in 3 or less days had no 30 days mortality compared with 19% (p=0.24) for patients who did not achieve CR by day 3. Conclusions: Delay in complete resolution of refractory or severe CID may increase risk of mortality. Chemotherapy-induced diarrhea in the in-patient setting is not managed according to the guideline recommendations and there is a significant need for education and awareness of morbidity and mortality associated with CID. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Novartis