Secondary Logo

Journal Logo

GASTROINTESTINAL SYMPTOMS: Edited by Rachel J. Gibson and Matthew A. Ciorba

Advances in understanding and improving gastrointestinal symptoms during supportive and palliative care

a decade of progress

Ciorba, Matthew A.

Author Information
Current Opinion in Supportive and Palliative Care: June 2016 - Volume 10 - Issue 2 - p 149-151
doi: 10.1097/SPC.0000000000000215
  • Free

This year marks the 10th anniversary for our journal, Current Opinion in Supportive and Palliative Care. For this occasion, I am taking the opportunity to reflect upon how the field has progressed over this time focusing particular attention on managing gastrointestinal symptoms. This decade has provided major advances in cancer treatment highlighted by wider application of tyrosine kinase inhibitors and the introduction of new classes of therapies that harness the power of the body's own immune system to attack cancer. In addition, genomics and novel biomarkers are now routinely used in the clinic to select which patients are most likely to respond to specific therapeutic regimens. Despite these advances, off-target gastrointestinal toxicities remain a pervasive challenge. For these reasons, attention to advances in symptomatic supportive and palliative care remain a strategic priority for improving the quality of life for patients affected by serious and life-threatening diseases such as cancer.

Over the past 10 years, the journal has addressed this challenge, typically publishing five to seven outstanding reviews on these topics per year. Notably, in its first year, there was a heavy focus on mucositis related to cytotoxic therapies, including radiation and alkaloid-based chemotherapies [1–5]. Subsequent issues focused on understanding the management of both the short- and long-term gastrointestinal side-effects and consequences of chemotherapy and radiation therapy [6–13]. Important insight has also been provided on weight loss as well as nutrition support options for patients in need of supportive and palliative care [14–16]. Investigators and clinicians have also shared their valuable knowledge on novel approaches to understanding therapy-related intestinal toxicities, including symptom clustering [17], physiologic approaches [18], pathophysiologic mechanisms [19–22], new measurement tools/approaches [23–27], and understanding of therapy-specific toxicities [28,29].

As the field of cancer therapies has progressed, our journal has provided timely reviews and insights to their toxicities. Keefe, Bossi, Bowen, and colleagues [30–33] shed light on the challenges and toxicities associated with targeted therapies including tyrosine kinase inhibitors. This year, Van Sebille and coinvestigators [34] detail the specific gastrointestinal toxicities of first and second-generation small molecule tyrosine kinase inhibitors with a focus on nonsmall cell lung cancer.

Gut microbiota and natural therapies have also been a topic of interest recently. Oral health, involvement of the upper gastrointestinal tract, and palliative surgical approaches have also been covered in important detail [35–41]. Reflecting a surge of patient and provider interest [42,43], we have seen interest in covering novel therapies to reduce toxicity to normal gastrointestinal tissues, including probiotics and microbial-derived products [44,45]. The exciting area of host–microbe cross-talk in relation to cancer therapy was covered in excellent detail last year by Vanhoecke and Stringer [46]. Last year, Marx and colleagues [47] also provided a delightful review examining the data and mechanisms of ginger as a natural approach to limit symptoms of nausea and vomiting. Novel biomarkers of normal tissue toxicity [48,49], infection-related mortality [50], and gastrointestinal pathology after stem cell transplant have also been addressed.

In the current issue, we have another outstanding collection of review articles seasoned with authors’ opinions. Bosnjak and colleagues (pp. 180–188) provide a timely and thorough review examining a repurposing of the antipsychotic drug olanzapine as an important strategy for treating both cancer and chemotherapy-induced nausea and vomiting. Cairo (pp. 157–164) elegantly illustrates the importance of Toll-like receptors in the pathogenesis of chemotherapy-induced intestinal toxicity paying particular attention to new data related to Toll-like receptor 2. Eyob et al. (pp. 165–179) grace our format by providing original data from a large cohort of patients examining the impact of chemotherapy on cancer-related fatigue and identifying differences in cytokines changes based on the type of therapy used. Finally, van Eeden and Rapaport (pp. 189–194) share with us an up-to-date review on the management of anemia in solid and hematologic malignancy highlighting the risks and benefits of using erythropoiesis-stimulating agents and transfusions.

Beyond the remarkable insight gained from each issue, an important aspect of this journal has been to include insight and opinions from authors around the world. You can see that this is achieved again this year with contributors from Australia, Germany, Serbia, Montenegro, South Africa, and Singapore. The worldly perspective brought forth by my esteemed colleagues is infrequently represented to this degree in other journals and highlights the important role for this journal now and for its longevity. So here is a virtual toast to the achievements of this decade past and to what will surely be a bright decade ahead of advances in supportive and palliative care directed at improving the quality of life for all those in need.

Acknowledgements

None.

Financial support and sponsorship

This work was supported by 1R21CA206039-01.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Keefe DM. Supportive care silos: time to forge cross-links, using mucositis as an example. Curr Opin Support Palliat Care 2007; 1:40–42.
2. Hauer-Jensen M, Wang J, Boerma M, et al. Radiation damage to the gastrointestinal tract: mechanisms, diagnosis, and management. Curr Opin Support Palliat Care 2007; 1:23–29.
3. Garden AS, Chambers MS. Head and neck radiation and mucositis. Curr Opin Support Palliat Care 2007; 1:30–34.
4. Blijlevens NM. Cytotoxic treatment-induced gastrointestinal symptoms. Curr Opin Support Palliat Care 2007; 1:16–22.
5. Anthony L. Irinotecan toxicity. Curr Opin Support Palliat Care 2007; 1:35–39.
6. Ellebæk E, Herrstedt J. Optimizing antiemetic therapy in multiple-day and multiple cycles of chemotherapy. Curr Opin Support Palliat Care 2008; 2:28–34.
7. Clemens KE, Klaschik E. Management of constipation in palliative care patients. Curr Opin Support Palliat Care 2008; 2:22–27.
8. Gibson RJ, Stringer AM. Chemotherapy-induced diarrhoea. Curr Opin Support Palliat Care 2009; 3:31–35.
9. Yeoh E. Radiotherapy: long-term effects on gastrointestinal function. Curr Opin Support Palliat Care 2008; 2:40–44.
10. Wedlake LJ, Andreyev HJN. Manipulating the consequential effect: an alternative approach to reducing pelvic radiation disease other than dose reduction. Curr Opin Support Palliat Care 2011; 5:25–28.
11. Dennis K, Poon M, Chow E. Nausea and vomiting induced by gastrointestinal radiation therapy: current status and future directions. Curr Opin Support Palliat Care 2015; 9:182–188.
12. Stacey R, Green JT. Nonendoscopic therapies for the management of radiation-induced rectal bleeding. Curr Opin Support Palliat Care 2013; 7:175–182.
13. Dunberger G, Bergmark K. Nurse-led care for the management of side effects of pelvic radiotherapy: what does it achieve? Curr Opin Support Palliat Care 2012; 6:60–68.
14. Baldwin C. Nutritional support for malnourished patients with cancer. Curr Opin Support Palliat Care 2011; 5:29–36.
15. Jatoi A. Weight loss in patients with advanced cancer: effects, causes, and potential management. Curr Opin Support Palliat Care 2008; 2:45–48.
16. Talwar B, Findlay M. When is the optimal time for placing a gastrostomy in patients undergoing treatment for head and neck cancer? Curr Opin Support Palliat Care 2012; 6:41–53.
17. Aprile G, Ramoni M, Keefe D, et al. Links between regimen-related toxicities in patients being treated for colorectal cancer. Curr Opin Support Palliat Care 2009; 3:50–54.
18. Andreyev HJ. A physiological approach to modernize the management of cancer chemotherapy-induced gastrointestinal toxicity. Curr Opin Support Palliat Care 2010; 4:19–25.
19. Al-Dasooqi N. Matrix metalloproteinases and gut toxicity following cytotoxic cancer therapy. Curr Opin Support Palliat Care 2014; 8:164–169.
20. Wardill HR, Bowen JM. Chemotherapy-induced mucosal barrier dysfunction: an updated review on the role of intestinal tight junctions. Curr Opin Support Palliat Care 2013; 7:155–161.
21. Melichar B, Zezulová M. The significance of altered gastrointestinal permeability in cancer patients. Curr Opin Support Palliat Care 2011; 5:47–54.
22. Kissow H. Glucagon-like peptides 1 and 2: intestinal hormones implicated in the pathophysiology of mucositis. Curr Opin Support Palliat Care 2015; 9:196–202.
23. Butler RN. Measuring tools for gastrointestinal toxicity. Curr Opin Support Palliat Care 2008; 2:35–39.
24. Abernethy AP, Wheeler JL, Zafar SY. Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposed approach. Curr Opin Support Palliat Care 2009; 3:41–49.
25. West CM, Davidson SE. Measurement tools for gastrointestinal symptoms in radiation oncology. Curr Opin Support Palliat Care 2009; 3:36–40.
26. Rangwala F, Zafar SY, Abernethy AP. Gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, insights, and a proposed approach. Curr Opin Support Palliat Care 2012; 6:69–76.
27. Clemens KE, Faust M, Jaspers B, et al. Pharmacological treatment of constipation in palliative care. Curr Opin Support Palliat Care 2013; 7:183–191.
28. Wong NA. Gastrointestinal pathological changes in stem cell transplant patients. Curr Opin Support Palliat Care 2014; 8:170–179.
29. Sonis ST. Regimen-related gastrointestinal toxicities in cancer patients. Curr Opin Support Palliat Care 2010; 4:26–30.
30. Keefe D, Anthony L. Tyrosine kinase inhibitors and gut toxicity: a new era in supportive care. Curr Opin Support Palliat Care 2008; 2:19–21.
31. Keefe D, Stringer A. The potential successes and challenges of targeted anticancer therapies. Curr Opin Support Palliat Care 2010; 4:16–18.
32. Bossi P, Lucchesi M, Antonuzzo A. Gastrointestinal toxicities from targeted therapies: measurement, duration and impact. Curr Opin Support Palliat Care 2015; 9:163–167.
33. Bowen JM. Mechanisms of TKI-induced diarrhea in cancer patients. Curr Opin Support Palliat Care 2013; 7:162–167.
34. Van Sebille YZA, Gibson RL, Wardill HR, et al. Gastrointestinal toxicities of first and second generation small molecule HER TKIs in advanced non-small cell lung cancer. Curr Opin Support Palliat Care 2016; 10:152–156.
35. Kraaijenga SAC, van der Molen L, van den Brekel MWM, et al. Current assessment and treatment strategies of dysphagia in head and neck cancer patients: a systematic review of the 2012/13 literature. Curr Opin Support Palliat Care 2014; 8:152–163.
36. Vlavianos P, Zabron A. Clinical outcomes, quality of life, advantages and disadvantages of metal stent placement in the upper gastrointestinal tract. Curr Opin Support Palliat Care 2012; 6:27–32.
37. Logan RM. Links between oral and gastrointestinal health. Curr Opin Support Palliat Care 2010; 4:31–35.
38. Laheij AMGA, de Soet JJ. Can the oral microflora affect oral ulcerative mucositis? Curr Opin Support Palliat Care 2014; 8:180–187.
39. Kolomainen DF, Barton DP. Surgical management of bowel obstruction in gynaecological malignancies. Curr Opin Support Palliat Care 2011; 5:55–59.
40. Shariff MIF, Khan SA, Westaby D. The palliation of cholangiocarcinoma. Curr Opin Support Palliat Care 2013; 7:168–174.
41. Whistance RN, Blazeby JM. Systematic review: quality of life after treatment for upper gastrointestinal cancer. Curr Opin Support Palliat Care 2011; 5:37–46.
42. Williams MD, Ha CY, Ciorba MA. Probiotics as therapy in gastroenterology: a study of physician opinions and recommendations. J Clin Gastroenterol 2010; 44:631–636.
43. Ciorba MA. A gastroenterologist's guide to probiotics. Clin Gastroenterol Hepatol 2012; 10:960–968.
44. Berbée M, Hauer-Jensen M. Novel drugs to ameliorate gastrointestinal normal tissue radiation toxicity in clinical practice: what is emerging from the laboratory? Curr Opin Support Palliat Care 2012; 6:54–59.
45. Ciorba MA, Hallemeier CL, Stenson WF, et al. Probiotics to prevent gastrointestinal toxicity from cancer therapy: an interpretive review and call to action. Curr Opin Support Palliat Care 2015; 9:157–162.
46. Vanhoecke B, Stringer A. Host–microbe cross talk in cancer therapy. Curr Opin Support Palliat Care 2015; 9:174–181.
47. Marx W, Kiss N, Isenring L. Is ginger beneficial for nausea and vomiting? An update of the literature. Curr Opin Support Palliat Care 2015; 9:189–195.
48. Henson CC, Ang YS. Biomarkers of normal tissue toxicity after pelvic radiotherapy. Curr Opin Support Palliat Care 2012; 6:33–40.
49. Gibson RJ. The urgent need for an effective biomarker for cytotoxic therapy-induced adverse effects. Curr Opin Support Palliat Care 2013; 7:153–154.
50. Sedef AM, Kose F, Mertsoylu H, et al. Procalcitonin as a biomarker for infection-related mortality in cancer patients. Curr Opin Support Palliat Care 2015; 9:168–173.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.