Amino Acids Could Reduce Cancer Treatment–Related Diarrhea

Treatment-related diarrhea is a common adverse event (AE) associated with cancer-directed therapies, negatively affecting patients’ quality of life (QOL) and leading to treatment delays and/or dose reductions that could affect morbidity and mortality. Findings from a study presented at JADPRO Live Virtual 2021 suggest that amino acid oral rehydration solution (AA-ORS) could be a useful adjunct therapy to reduce the incidence of treatment-related diarrhea among patients with cancer, as well as improve their QOL.

“Amino acids help to rebuild and protect the gastrointestinal mucosa and hydrate the patient by repair of the damaged mucosa with cellular regeneration of the villi and crypt cells,” explained study author Holly Chitwood, DNP, APRN, FNP-C, AGACNP-BC, from the University of Kentucky Markey Cancer Center. AA-ORS “thereby enhances nutrient, electrolyte, and fluid absorption.”

With this nonrandomized interventional study, Dr. Chitwood and researchers evaluated the use of AA-ORS to reduce the severity of treatment-related diarrhea, to improve patient-reported QOL, and to improve selected treatment outcomes associated with this adverse event.

The prospective study included 22 patients who were treated at the University of Kentucky Markey Cancer Center. Patients completed a survey on enrollment and then 12 to 21 days after starting AA-ORS (two 8-ounce servings per day). Patients also received standard antidiarrheal medication (lomotil and loperamide).

Among the study population, the most common cancer diagnoses were colorectal and lung cancer (n=7 and n=8, respectively). The most common cancer-directed treatment was a 5-fluorouracil regimen with irinotecan (n=6; 27%).

Dr. Chitwood collected information on patients’ Common Terminology Criteria for Adverse Events (CTCAE) grade of diarrhea, stool consistency using the Bristol Stool Scale, use of antidiarrheal medications, use of AA-ORS, associated symptoms, and QOL (per the Functional Assessment of Chronic Illness Therapy-Diarrhea questionnaire) were recorded, as well as changes in cancer-directed treatment.

Only 16 of the enrolled patients completed both the pre- and post-intervention survey. There was no statistically significant difference between pre- and post-intervention survey responses to physical function, functional status, satisfaction with coping, or pain. There also were no significant changes in the dose reductions, delays, or holds of cancer treatment after the start of AA-ORS.

There was a statistically significant improvement in symptoms such as nausea, abdominal pain, weight loss, muscle weakness and cramping, dehydration, appetite, and electrolyte imbalances, with the exception of hypokalemia (TABLE). Dr. Chitwood also observed decreased CTCAE grade of diarrhea, including a reduction in the frequency of stools per day and a change in the consistency of stools moving from watery to more formed stools.

During the follow-up period, patients reported greater use of antidiarrheal medications, which may have also attributed to the self-reported reduction of diarrhea, Dr. Chitwood noted.

Although these findings suggest a role for AA-ORS as adjunctive therapy for patients receiving chemotherapy, Dr. Chitwood noted that this study needs to be replicated with a larger, more inclusive sample size to further support the use of AA-ORS in this setting.

The authors report no relevant conflicts of interest.

Reference

Chitwood H. Utilization of an amino acid-oral rehydration solution to reduce treatment-related diarrhea and improve quality of life in solid tumor cancer patients. Poster JL920. Presented at JADPRO Live Virtual, October 7-17, 2021.

TABLE. Comparison of quality-of-life measures and diarrhea-related symptoms on pre- and post-intervention surveys

Pre-Intervention Survey Post-Intervention Survey
Nausea 57% 37%
Abdominal pain 48% 26%
Weight Loss 61% 53%
Muscle weakness 35% 26%
Muscle cramping 17% 16%
Dehydration 65% 21%
Decreased appetite 65% 47%
Hypomagnesemia 39% 33%
Hypocalcemia 17% 11%
Hypokalemia 39% 42%