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Cancer Treatment Side Effects

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Treatment Intentions

Supportive Patient Care
There are over 14 million people diagnosed with cancer who will likely receive chemotherapy and/or radiation as well as the accompanying treatment related gastrointestinal (GI) side effects. 2 The majority of patients experience these side effects including diarrhea, dehydration and oral mucositis (painful swelling of the tissue in the mouth).3
Depending upon the treatment regimen and individual patient variability, the patient’s reaction to therapy may vary. As a healthcare provider you understand that early supportive therapy can help limit or prevent acute and chronic complications, for this reason you may consider adding supportive care medications along with proper diet and hydration to manage these side effects.
Entrinsic Health Solutions developed enterade® to help manage the unique nutritional needs of patients receiving treatments for cancer. Adding enterade®to your patient’s daily routine can help manage and maintain GI function and provide the nutrients and hydration needed to minimize the side effects of cancer therapy. enterade® improves how patients feel so they can fight back and remain on necessary therapy.

The Effects of Chemotherapy and Radiation on Patient Treatment

Drinking enterade® Throughout Treatment
Can Help Reduce and Manage GI-related side effects.

GI symptoms are the most common of all the acute and chronic physical side effects of the treatment of cancer,have the greatest impact on the patient’s quality of life and may lead to a reduction in treatment dosing or possible discontinuation of therapy.8 A portion of patients have ongoing GI problems. Specific drug treatments together with the degree of damage to the mucosa and submucosa may also play a role in the development of chronic GI problems.9

Challenges of the Patient Experience

Feel Better With enterade®
Treatment Induced Dehydration: This is a normal side effect of cancer therapy. Severe dehydration can increase a patient’s risk of electrolyte deficiency and may require hospitalization, invasive IV rehydration, decreasing the patients quality of life. Percentage of people requiring IV hydration and/ or electrolyte replacement during cancer therapy is approx 73%. 13

Treatment Induced Diarrhea: Severe and life-threatening diarrhea can occur in up to 30% of cancer patients.16 Despite the high incidence and potential severity of chemotherapy induced diarrhea, it is often under recognized, poorly understood and improperly managed.16
Radiation-induced diarrhea occurs with varying incidence of severity based upon, field size, fraction size and total dose of radiation given, and can be severe and in some cases life threatening. The incidence of grade 3/4 diarrhea ranges from 20% to 40% in patients receiving a combined chemoradiotherapy.17

Absorption

The treatment of cancer indiscriminately targets rapidly dividing cells in the GI tract. One specific section impacted are the villi and crypt regions of the intestinal mucosa.18
The villi promote proper absorption of nutrients, electrolytes, and fluids. A crucial area in the villi is located on the tip, where glucose is absorbed. In healthy villi, glucose is used as a transport mechanism to promote proper absorption. However, in patients undergoing the treatment of cancer, the villi may be blunted and their absorptive properties are greatly diminished leading to, reduced nutrient absorption and dehydration. In a damaged GI system, blunted villi are unable to absorb glucose-bound nutrients and electrolytes.
Specific GI dysfunction caused by cancer treatment include:
• Intestinal villi blunting- altered nutrient absorption
• Reduced crypt cells-decreased regeneration of cells for healing and repair

This image (left) depicts a view of a gut barrier junction that has not been irradiated (normal cell junction). The image in the center shows a view of damaged irradiated barrier junction, with a clear space formation between the cells. The image on the right shows the rebuilt gut barrier junction complex, post irradiated, with a tight barrier after taking enterade®. Note that the post irradiated barrier, after taking enterade® is tighter, than the non irradiated cell (normal cell).

Gut Barrier Function

The mucosa of the GI tract is lined by a single layer of epithelial cells which separate luminal contents from the internal milieu of the body.19 They play a key role in the mediation of intestinal homeostasis and help maintain an immunological environment conducive to normal function and health.20

The enterocytes act as the main physical barrier preventing harmful pathogens, (i.e. toxins and or bacteria) from entering the mucosa20, 21, & 22. When these regions are exposed to a toxic environment (e.g. treatment of cancer) the integrity of the gut barrier function is compromised resulting in antigenic translocation. Bacterial translocation can cause local and systemic inflammation resulting in the following side effects: diarrhea, oral mucositis, dehydration, and general GI symptoms.
Similarly, research has shown that glucose can cause active chloride secretion in the enterocyte which reduces net fluid absorption, and increases fluid and electrolyte loss, exacerbating GI dysfunction. Additionally, glucose has been shown to weaken the gut barrier function increasing paracellular permeability, which results in antigenic translocation and inflammation.23