British Society of Gastroenterology practice guidance on the management of acute and chronic gastrointestinal symptoms and complications as a result of treatment for cancer
Andreyev, Jervoise Adams, Richard Bornschein, Jan Chapman, Mark Chuter, Dave Darnborough, Sally Davies, Andrew Dignan, Fiona Donnellan, Clare Fernandes, Darren
Andreyev, Jervoise
Adams, Richard
Bornschein, Jan
Chapman, Mark
Chuter, Dave
Darnborough, Sally
Davies, Andrew
Dignan, Fiona
Donnellan, Clare
Fernandes, Darren
Affiliation
United Lincolnshire Hospitals NHS Trust; University of Nottingham; Cardiff University; University of Oxford; Oxford University Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; PPI Representative; Beatson West of Scotland Cancer Centre; Guy's and St Thomas' Hospitals NHS Trust; Manchester University NHS Foundation Trust; Leeds Teaching Hospitals NHS Trust; Nottingham University Hospitals NHS Trust; Beatson West of Scotland Cancer Centre; Royal Surrey NHS Foundation Trust; Cardiff and Vale University Health Board; Barking Havering and Redbridge Hospitals NHS Trust; Barts Health NHS Trust; University Hospitals Sussex NHS Foundation Trust; King's College Hospital NHS Foundation Trust; University of Liverpool; London North West Healthcare NHS Trust; Royal Marsden Hospital NHS Trust
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Publication date
2025-06-06
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Abstract
Background: Survival rates after a diagnosis of cancer are improving. Poorly managed gastrointestinal (GI) side effects can interfere with delivery of curative cancer treatment. Long-term physical side effects of cancer therapy impinge on quality of life in up to 25% of those treated for cancer, and GI side effects are the most common and troublesome.
Aim: To provide comprehensive, practical guidance on the management of acute and chronic luminal gastrointestinal symptoms arising during and after treatment for cancer METHODS: A multidisciplinary expert group including patients treated for cancer, divided into working parties to identify, and synthesise recommendations for the optimal assessment, diagnosis and appropriate interventions for luminal GI side effects of systemic and local cancer therapies. Recommendations were developed using the principles of the BMJ AGREE II reporting.
Results: 103 recommendations were agreed. The importance of the patient perspective and what can be done to support patients are emphasised. Key physiological principles underlying the development of GI toxicity arising from cancer therapy are outlined. Individual symptoms or symptom clusters are poor at distinguishing the underlying cause(s), and investigations are required if empirical therapy does not lead rapidly to significant benefits. Patients frequently have multiple GI causes for symptoms; all need to be diagnosed and optimally treated to achieve resolution. Investigations and management approaches now known to be ineffective or of questionable benefit are highlighted.
Conclusions: The physical, emotional and financial costs to individuals, their families and society from cancer therapy can be considerable. Identifying and signposting affected patients who require specialist services is the role of all clinicians. Progress in the treatment of cancer increasingly means that patients require expert, multidisciplinary supportive care providing effective and safe treatment at every stage of the cancer journey. Development of such expertise should be prioritised as should the education of health professionals and the public in what, when and how acute and chronic gastrointestinal symptoms and complications should be managed.
Citation
Andreyev J, Adams R, Bornschein J, Chapman M, Chuter D, Darnborough S, Davies A, Dignan F, Donnellan C, Fernandes D, Flavel R, Giebner G, Gilbert A, Huddy F, Khan MSS, Leonard P, Mehta S, Minton O, Norton C, Payton L, McGuire G, Pritchard DM, Taylor C, Vyoral S, Wilson A, Wedlake L. British Society of Gastroenterology practice guidance on the management of acute and chronic gastrointestinal symptoms and complications as a result of treatment for cancer. Gut. 2025 Jun 6;74(7):1040-1067. doi: 10.1136/gutjnl-2024-333812.
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Article