Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA.
Curr Opin Support Palliat Care. 2012 Mar;6(1):69-76. doi: 10.1097/SPC.0b013e32834f689d.
This review summarizes recent developments in the management of gastrointestinal symptoms experienced by cancer patients and provides a framework for education, assessment and monitoring, and treatment.
Although many viable treatment options exist, gastrointestinal symptoms - particularly nausea and vomiting, constipation, and diarrhea - continue to challenge both patients and clinicians. Current clinical guidelines now recommend that patients treated with moderate emetic risk chemotherapy regimens be preferentially treated with the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, palonosetron, in combination with dexamethasone. A large randomized trial has also recently validated that single-dose fosaprepitant is equivalent to the standard 3-day, aprepitant regimen. New medications, such as skin patch delivery of granisetron for nausea or methylnaltrexone for constipation, show promise in both the management of symptoms and as preventive agents. The integration of complementary and alternative therapies, such as relaxation techniques, ginger, 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 disproportionate with objective measures. New methodologies that harness technology to collect patient-reported outcomes may improve the accuracy of assessment, provide a better picture of the patient's experience of gastrointestinal symptoms, and deliver a means to simultaneously monitor symptoms, educate patients, and collect longitudinal data.
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. When combined with refinements in the overall clinical approach to symptom management, standardized instruments that streamline data collection and enable data warehousing will support better symptom management.
本文总结了癌症患者胃肠道症状管理的最新进展，并为教育、评估、监测和治疗提供了一个框架。
尽管有许多可行的治疗选择，但胃肠道症状——尤其是恶心和呕吐、便秘和腹泻——仍然给患者和临床医生带来挑战。目前的临床指南建议，接受中度致吐风险化疗方案治疗的患者，优先使用 5-羟色胺 3（5-HT3）受体拮抗剂，即帕洛诺司琼，联合地塞米松治疗。一项大型随机试验最近还证实，单剂量福沙匹坦等效于标准的 3 天阿瑞匹坦方案。新的药物，如用于恶心的格拉司琼透皮贴剂或用于便秘的甲基纳曲酮，在症状管理和预防方面都有希望。补充和替代疗法的整合，如放松技术、生姜和电针，也可能有助于缓解症状。准确的评估至关重要，但往往存在问题，尤其是当患者的胃肠道不适体验与客观测量不成比例时。利用技术收集患者报告结果的新方法可能会提高评估的准确性，更全面地了解患者的胃肠道症状体验，并提供一种同时监测症状、教育患者和收集纵向数据的手段。
晚期癌症患者胃肠道症状的姑息治疗需要多管齐下的方法，包括有效的评估、明智地使用最新的循证方法以及监测，包括临床措施和患者报告结果。当与症状管理的整体临床方法的改进相结合时，标准化的工具将简化数据收集并实现数据存储，从而支持更好的症状管理。
