Cancer Treatment Induced Diarrhea (CTID) & Mucositis

Question 1

Irinotecan induced diarrhea

Answer 1

can be acute or delayed

acute:
- due to cholinergic stimulation
- mean duration is 30 min
- usually respond rapidly to atropine

delayed:
- due to GI mucosal damage
- usually occur more than 24hrs after admin
- noncumulative and occurs at all dose levels

Question 2

Non-pharm CTID management

Answer 2

avoid foods that would aggravate
aggressive oral rehydration

Question 3

Pharmacologic CTID management:

Answer 3

Loperamide
Diphenoxylate-atropine

Question 4

Loperamide

Answer 4

4mg followed by 2 mg every 4h after every unformed stool

do not exceed 16mg/d (the package will say 8 mg/d but this does not apply to cancer patients)

Question 5

Diphenoxylate-atropine

Answer 5

Take 1-2 tablets every 6 hours until control achieved

not to exceed 8 tablets/d

Question 6

Treatment for refractory CTID

Answer 6

Octreotide
Tincture of opium
probiotics
rule out C. diff and infection colitis

Question 7

Mucositis

Answer 7

erythematous and ulcerative lesions of the mucosa observed in patients treated with chemotherapy

can occur anywhere in the GI tract

Question 8

Stomatitis

Answer 8

mucositis limited to the oral cavity

Question 9

Mucositis risk factors

Answer 9

Chemotherapy
- melphalan
- cisplatin + radiation
- high dose methotrexate
- doxorubicin
- busulfan
- 5 FU
Smoking
Poor oral hygiene
oral lesions at baseline
female
pretreatment nutritional status

Question 10

Grade 1 Mucositis

Answer 10

asymptomatic or mild sx -> no intervention

Question 11

Grade 2 Mucositis

Answer 11

Moderate pain or ulcer that does not interfere with PO intake -> modified diet indicated (liquid diet)

Question 12

Grade 3 Mucositis

Answer 12

severe pain interfering with PO intake -> intervention indicated

Question 13

Grade 4 Mucositis

Answer 13

life threatening consequences -> urgent intervention indicated

Question 14

Mucositis prevention

Answer 14

oral hygiene:
- avoid acidic or spicy foods
- brush with soft toothbrush BID
- floss daily
- switch tablets to solutions or IV if hospitalized
- use nonalcohol based mouthwash

cryotherapy:
- hold ice chips in mouth for 30 min before and/or during infusion of chemotherapy

Question 15

Mucositis Management: Oral Decontamination

Answer 15

Bland mouthwash or oncology mouthwash
Dexamethasone mouthwash for Eferolimus-induced mucositis

Question 16

Mucositis Management: Pain control

Answer 16

2% viscous lidocaine swish and spit
systemic opioids

Question 17

Mucositis Management: Palliation of dry mouth

Answer 17

Artificial saliva products
Chewing gum

Question 18

Mucositis Management: Nutritional support

Answer 18

liquid or soft diet
TPN

Question 19

Mucositis Management: Oral Candidiasis Treatment

Answer 19

Nystatin oral solution or clotrimazole lozenge

Fluconazole 200 mg PO x 1 dose, then 100mg daily x 21 days