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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

TM. The EPEC-O Project Education in Palliative and End-of-life Care - Oncology. The EPEC TM O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

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The EPEC-O Project Education in Palliative and End-of-life Care - Oncology

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  1. TM The EPEC-O Project Education in Palliative and End-of-life Care - Oncology The EPECTMO Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

  2. EPEC– Oncology Education in Palliative and End-of-life Care – Oncology Module 3i: Symptoms – Diarrhea

  3. Diarrhea . . . • Definition: stool that is looser than “normal” and /or increased in frequency

  4. . . . Diarrhea Epidemiology • Impact: • At best, annoying • At worst, life-threatening • Prevalence: • 30 to 90% of patients on some antineoplastic agents

  5. Key points • Pathophysiology • Assessment • Management

  6. Pathophysiology • 7 to 9 liters of fluid reach the large intestine daily • Loose stools occur if even less than100 ml not absorbed • Chemotherapy: damaged intestinal mucosa and increased fluid overwhelm large bowel capacity • Irinotecan has cholinergic effect

  7. Causes of diarrhea • Infections • Gastrointestinal bleeding • Malabsorption • Medications • Obstruction • Overflow incontinence • Stress

  8. Assessment • History • What is “normal” for the patient? • Description of stool (consistency, frequency, volume, blood, etc.) • Onset and duration of diarrhea • Presence of weight loss • Systemic symptoms • Medications can be causative (including chemotherapy) • Physical • Examine for signs of dehydration, fever

  9. Management • Establish normal bowel pattern • Avoid gas-forming foods • e.g., milk (lactose) • Increase bulk • Transient, mild diarrhea • Attapulgite • Bismuth salts

  10. Managementof persistent diarrhea • Loperamide • Diphenoxylate / atropine • Paregoric • Tincture of opium • Octreotide

  11. Chemotherapy-associated diarrhea • May be life-threatening • Aggressive oral hydration • Expectant management • Loperamide 4 mg then 2 mg q 2 h until diarrhea-free for 12 hours • Octreotide for refractory diarrhea • Admit for severe diarrhea, nausea, vomiting, fever, sepsis, or bleeding

  12. Carcinoid-associated diarrhea • Opioid for mild case • Cholestyramine • Octreotide

  13. Pancreatic insufficiency-associated diarrhea • Low-fat diet • Exogenous pancreatic lipase

  14. Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience.

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