Distinct diarrhea profiles during outpatient chemotherapy
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ORIGINAL ARTICLE
Distinct diarrhea profiles during outpatient chemotherapy Rafael Diaz 1 & Kord M. Kober 1 & Carol Viele 1 & Bruce A. Cooper 1 & Steven M. Paul 1 & Marilyn Hammer 2 & Fay Wright 3 & Yvette P. Conley 4 & Jon D. Levine 5 & Christine Miaskowski 1,6 Received: 12 May 2020 / Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Chemotherapy-induced diarrhea (CID) is a common symptom that occurs in 50 to 80% of patients. Given that the majority of the data on the occurrence and severity of CID is based on physician-rated toxicity criteria, this study’s purposes were to identify subgroups of patients with distinct CID profiles and determine how these subgroups differ in terms of demographic and clinical characteristics; severity, frequency, and distress of CID; the co-occurrence of common GI symptoms; and QOL. Methods Patients (n = 1133) completed the Memorial Symptom Assessment Scale six times over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct diarrhea profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics. Results Four distinct diarrhea profiles were identified: none (58.3%), decreasing (22.0%), increasing (5.2%), and high (14.5%). Compared with the none class, patients in the high class had a lower functional status, a worse comorbidity profile, were more likely to have gastrointestinal cancer, and were more likely to receive chemotherapy on a 14-day cycle. No differences were found among the classes in the percentages of patients who received chemotherapy with a targeted therapy. Conclusion Given that CID occurred in over 40% of the patients, clinicians should assess for this symptom and other common GI symptoms and initiate appropriate pharmacologic and dietary interventions. Keywords Diarrhea . Chemotherapy . Cancer . Quality of life . Latent class analysis
Introduction Chemotherapy-induced diarrhea (CID) is a common symptom that occurs in 50 to 80% of patients [34]. While the mechanisms that underlie CID are not well understood, it is defined as an increase in the frequency, above a patient’s baseline, of soft, loose, and watery stool [14]. Most of the prevalence rates
* Christine Miaskowski [email protected] 1
School of Nursing, University of California, San Francisco, CA, USA
2
Dana Farber Cancer Center, Boston, MA, USA
3
Rory Meyers College of Nursing, New York University, New York, NY, USA
4
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
5
School of Medicine, University of California, San Francisco, CA, USA
6
Department of Physiological Nursing, University of California, 2 Koret Way – N631Y, San Francisco, CA 94143-0610, USA
for CID are derived from studies that used the National Cancer Institute’s (NCI) Common Toxicity Criteria for Adverse Events (CTCAE) to grade CID based on its frequency and severity [1, 3, 27]. While CID is most commonly associated with the administration of fluoropyrimidin
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