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The importance of involving a gastroenterologist in oncology: GI toxicity can often be treated by doing simple GI investigations
Presentation by Dr. Jervoise Andreyev at MASCC/ISOO Annual Meeting June 23-25 2016, Adelaide
Professor Jervoise Andreyev is a Consultant Gastroenterologist in GI Consequences of Cancer Treatments at the Royal Marsden Hospital in London, UK. He set out to challenge the oncologist’s understanding of bowel symptoms, stating that in his experience, GI symptoms mean very little. To illustrate this, he presented a case study showing that in one patient (Hannah), six separate occasions of diarrhoea were each attributed to six different causes, which demonstrates the complexity of diarrhoea. Any insults to the GI tract can result in a pathological change, such as cell death, atrophy, inflammation or fibrosis.
Interestingly, pathology does not predict the symptoms; someone with very few pathological changes can have terrible symptoms and vice versa. Prof Andreyev stresses that fairly simple GI investigations can treat a number of underlying causes of GI symptoms prior to and during chemotherapy. This may allow for more chemotherapy and better treatment outcomes for individuals. GI toxicity is complex, and the oncologist must develop close links with an expert gastroenterologist. The case study patient Isabella is considered to be a high-risk patient to Prof Andreyev; having a 5% risk of death if not treated straight away. He reviews the importance of immediate treatment and a close monitoring plan for Isabella. Lastly, nutritional support should be provided by a trained dietician.
A short group discussion followed, where it was agreed that there’s no place for the attitude: “Well, you’ve got to put up with that symptom because of your disease”. Oncology has made a successful shift in the area of pain management, but not in many other symptoms, which are still accepted by oncologists on behalf of the patient. In the panel’s opinion, uncontrolled symptoms are being put up with by patients unnecessarily, which is not acceptable in 2016. Prof Currow stated that there are lots of tools available and there is no excuse not to use them.