British Society of Gastroenterology practice guidance on the management of acute and chronic gastrointestinal symptoms and complications as a result of treatment for cancer.

Although UK-focused, these guidelines offer useful insights for global healthcare professionals.

This guidance document is intended for health professionals who see patients during and after treatment for cancer who have gastrointestinal issues which could be affecting their quality of life or potentially interfering with the effective delivery of their treatment for cancer. In a rapidly evolving area, it also touches on future perspectives.

There is little definitive evidence, and so recommendations are primarily based on expert opinion.

Many areas are addressed, and key points from the patient’s perspectives include acute symptoms, pain, all treatment pathways, late effects and commonly occurring conditions.

Background:

Survival rates after a diagnosis of cancer are improving, but poorly managed gastrointestinal (GI) side effects can interfere with the delivery of curative cancer treatment.

Long-term physical side effects of cancer therapy can influence the quality of life in up to 25% of those treated for cancer, and GI side effects are the most common and troublesome.

Aim:

To provide comprehensive and practical guidance on managing acute and chronic luminal (inside of the digestive system) gastrointestinal symptoms arising during and after cancer treatment.

Methods:

A multidisciplinary expert group, including patients treated for cancer, formed working parties to identify and build recommendations for the optimal assessment, diagnosis and appropriate interventions for luminal GI side effects of systemic and local cancer therapies. Recommendations were developed using the principles of the BMJ AGREE II reporting, a widely used and internationally accepted standard for assessing practical guidelines.

Results:

103 recommendations have been agreed, including the importance of the patient perspective and what can be done to support patients is emphasised.

Key physiological principles underlying the development of GI toxicity and tolerability arising from cancer therapy are outlined.

Individual symptoms or symptom clusters are poor at distinguishing the underlying cause(s). Investigations are required if therapy based on experience and observation does not rapidly lead to significant benefits.

Patients frequently have multiple GI causes for symptoms; all need to be diagnosed and optimally treated to achieve resolution.

Investigations and management approaches now known to be ineffective or of questionable benefit are highlighted.

Conclusions:

The physical, emotional and financial costs to individuals, their families and society from cancer therapy can be considerable.

Identifying and signposting affected patients who require specialist services is the role of all clinicians and Health Care professionals.

Progress in the treatment of cancer increasingly means that patients require expert, multidisciplinary, supportive care, providing effective and safe treatment at every stage of the cancer journey.

The development of such expertise should be prioritised, as should the education of health professionals and the public on what, when, and how acute and chronic gastrointestinal symptoms and complications should and can be managed.

PPI:

There were 2 PPI advisory partners (Dave Chuter and Robert Flavel) involved with the research team from the design and development of the study; both helped facilitate the PPI working and focus groups with other patients, carers and family members, which was fed back to the whole research team, this ensured the patient voice was at the heart of the study.

Dissemination:

The PPI advisors led the dissemination to the public, patients, charities, and patient organisations via their networks and connections.

Read more here.

Author:

Dave Chuter