The effectiveness of octreotide in managing chemotherapy-induced diarrhoea

Abstract

Background: Diarrhoea is one of the most common side effects experienced by cancer patients after having been administered chemotherapy (Stein, 2010). Locally, symptoms are commonly managed with antidiarrhoeal medication such as Loperamide and opioids. From my observations as a nurse working in an oncology setting, I have seen patients being hospitalised to manage symptoms, and in addition, having chemotherapy delays due to persistent diarrhoea. Hence, treatment efficacy is diminished. This dissertation investigates the effectiveness of Octreotide as a medication used to treat chemotherapy-induced diarrhoea (CID). Research question: In adult cancer patients (P-Population), is Octreotide (IIntervention) effective in managing chemotherapy-induced diarrhoea (O-Outcome)? Methods: An extensive search was conducted using various databases (HyDi, PubMed, CINHAL, and Google Scholar). Only articles published in English within the last 25 years, involving only adult cancer patients receiving active chemotherapy treatment, and suffering from grade 2-4 diarrhoea were included. The exclusion criteria eliminated literature comprising of participants on opiates or antidiarrhoeal treatment, receiving radiotherapy, and having a history of gastrointestinal problems. Five studies met the inclusion criteria; a prospective trial and randomised controlled trial (RCT) were retrieved in full-text from the online databases. An RCT was obtained through e-mail from one of the authors, whilst the systematic review and an additional RCT, were acquired through personal contacts. Studies were appraised according to their design using the Critical Appraisal Skills Programme (CASP) tools. Results: All the studies retrieved showed that Octreotide is successful in resolving CID in a median of 3-4 days, which is faster when compared to other therapies. A reduction in patients needing hospitalisation was observed, thus maintaining costeffectiveness. Minimal side effects to Octreotide were also reported. Conclusion: Octreotide is highly indicative of managing CID, however findings accentuate the need for further studies comparing Octreotide with other treatments, in addition to the possibility of administering Octreotide prophylactically prior to chemotherapy. Comparison of hospital costs with that of treating CID was recommended. Larger sampled and multicentre trials were also suggested. Proposals for implications were presented including informational lectures for disseminating the findings and benefits of Octreotide amongst healthcare professionals (HCP), whilst multidisciplinary team (MDT) meetings for education and possible implementation of the drug were also recommended.