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Education in Palliative and End-of-life Care - Oncology

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

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  1. The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O 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 – 90 % of patients on some anti-neoplastic agents

  5. Key points • Pathophysiology • Assessment • Management

  6. Pathophysiology • 7 – 9 liters of fluid reaches the large intestine daily • Loose stools with < 100 ml not absorbed • Chemotherapy: damaged intestinal mucosa and increased fluid overwhelms large bowel capacity • Irinotecan has cholinergic effect

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

  8. Assessment • History • What is ‘normal’ • Description (consistency, frequency, volume, blood, etc) • Onset and duration • Weight loss • Systemic symptoms • Medications (including chemotherapy) • Physical • Dehydration, fever

  9. Management • Establish normal bowel pattern • Avoid gas-forming foods • Eg, 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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