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Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposed approach

Abernethy, Amy P; Wheeler, Jane L; Zafar, S Yousuf

Current Opinion in Supportive and Palliative Care: March 2009 - Volume 3 - Issue 1 - p 41–49
doi: 10.1097/SPC.0b013e32832531ce
Gastrointestinal symptoms: Edited by Dorothy M.K. Keefe and Lowell Anthony

Purpose of review This review summarizes recent developments in the palliative management of gastrointestinal symptoms experienced by advanced cancer patients and provides a framework for detailing that encompasses education, assessment and monitoring, and treatment.

Recent findings Although many viable treatment options exist, gastrointestinal symptoms, particularly nausea and vomiting, constipation, and diarrhea, continue to challenge both patients and clinicians. New medications, such as skin patch delivery of granisetron for nausea or methylnaltrexone for constipation, show promise of better symptom management, and are advancing alongside an increasing emphasis on prevention. The integration into care plans of complementary and alternative therapies, such as relaxation techniques and electroacupuncture, may also assist with symptom relief. Accurate assessment is essential but often problematic, especially as the patient's experience of gastrointestinal distress is often incommensurate with objective measures. New methodologies that harness technology to collect patient-reported outcomes may improve the accuracy of assessment, better capture the patient's experience of gastrointestinal symptoms, and provide a means to simultaneously monitor symptoms, educate patients, and collect longitudinal data.

Summary Palliative management of gastrointestinal symptoms in advanced cancer patients requires a multipronged approach that entails effective assessment, judicious use of latest evidence-based approaches, and monitoring that incorporates both clinical measures and patient-reported outcomes. In combination with refinements in the overall clinical approach to symptom management, the deployment of standardized instruments that streamline data collection and enable data warehousing will support better symptom management.

Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA

Correspondence to Amy P. Abernethy, MD, Associate Professor, Duke University Medical Center, Box 3436, Durham, NC 27710 USA Tel: +1 919 668 0647; fax: +1 919 681 7985; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.