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, nausea/vomiting, dehydration, oral mucositis (painful swelling of the tissue in the mouth), and gastritis.3

Depending upon the treatment regimen and individual patient variability, the patient’s reaction to therapy may vary. As a physician 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.

This image highlights the side effects that may occur in the GI tract from chemotherapy and radiation treatments. (references)

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 and 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 proportion 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

While chemotherapy and radiation treatments act aggressively on the growing cancer cells, they also target and affect healthy non-cancerous cells. Among these healthy cells are those that are rapidly regenerating. The most sensitive and vulnerable of these cells are found in the lining of the GI tract, mouth and stomach.

The risks, severity, and incidence of GI symptoms from receiving chemotherapy or radiation are affected by various factors including:

riskfactors1

riskfactors2

Challenges of the Patient Experience

Feel Better With enterade®

Treatment Induced Nausea and Vomiting
Treatment induced nausea and vomiting related to chemotherapy can occur despite the use of appropriate antiemetic prophylaxis. Many patients experience clinically significant chemotherapy induced nausea and vomiting.10 While patients report treatment induced nausea and vomiting as the most distressing among all side effects, the prevalence is often underestimated by Healthcare Professionals.11,12 Treatment induced nausea and vomiting is also frequently underreported by patients due to symptom delay.12,13  Patients report nausea and vomiting as the most concerning among all side effects of cancer therapy.11

Treatment induced nausea and vomiting related to radiation injury occurs causing GI dysfunction. The severity of distress correlates with the radiation dosing.14 Most patients exposed to radiation, especially in the abdomen or pelvis areas develop acute symptoms.14

Treatment Induced Mucositis Mucositis may be caused by either radiation therapy or chemotherapy. Care of mucositis during chemotherapy and radiation therapy include little more than cleaning the mouth, swishing ice chips and relieving pain. 15

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 life threatening. The incidence of grade 3/4 diarrhea ranges from 20% to 40% in patients receiving a combined chemoradiotherapy.17

A study of patient preferences and symptom distress demonstrates the symptoms most feared by patients.11

  • Treatment Induced Nausea and Vomiting
  • Treatment Induced Mucositis
  • Treatment Induced Diarrhea

The assessment of patient preference and side effect evaluation revealed nausea and vomiting, mucositis, and diarrhea to be the most distressing among all symptoms.11

How Treatment for Cancer Affects the GI System

enterade® Delivers Improved GI Health by Rebuilding, Protecting, and Hydrating

Absorption

The treatment of cancer indiscriminately targets rapidly dividing cells in the GI tract. One specific section impacted are the villis  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 retention, resulting in improper nutrient absorption and dehydration. In a damaged GI system, the 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 generation of cells for healing and repair

Gut Barrier Function

The mucosa of the GI tract is lined by a single layer of epithelial cells  which separates 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 mucosa.20,21,22 When these regions are exposed to a toxic environment (e.g. treatment of cancer) the integrity of the gut barrier function is compromised leading to failure of tight junctions resulting in antigenic translocation. Bacterial translocation can cause local and systemic inflammation resulting in the following side effects: nausea/vomiting, diarrhea, oral mucositis, dehydration, and gastritis.

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

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).

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