A study looking at side effects of chemotherapy in cancers of the digestive system (FOCCUS)

The study team found that stomach and bowel symptoms caused by chemotherapy:

• need active management which isn’t normally done at the moment
• are often treatable or curable

About this study
People filled in a questionnaire that asked about stomach and bowel symptoms. They filled it in:

• before starting treatment
• then every month for a year

Of 241 people, 119 completed all the questionnaires. 

The team also took samples of their blood, urine and poo before treatment. This was to find out:

• how well their thyroid  was working
• the level of vitamin B12  in their blood
• how well their pancreas  was working

The team offered investigations for people who developed new symptoms or side effects. They told the person's doctor if the results were abnormal.   

Results
During the study more than 20 out of every 100 people (over 20%) reported ongoing inability to control their bowels (faecal incontinence). And more than 10 out of every 100 people (over 10%) reported having moderate to severe problems with:

• taste
• swallowing
• belching
• heartburn
• feeling full before completing their meal
• appetite
• feeling sick
• tummy (abdominal) cramps
• pain around the anus 
• passing wind (flatulence)
• rumbling and gurgling in the stomach and bowel
• urgent need to do a poo
• feeling of needing to pass poo even though their bowels are empty

The reporting of some side effects increased at the start of chemotherapy. These included:

• change in smell and taste
• pain around the anus
• passing wind 
• urgent need to do a poo

In the first 6 months of chemotherapy people reported some side effects as staying much the same. By 1 year these were less frequent. These included:

• bad breath
• loss of appetite
• bloating
• feeling and being sick
• rumbling and grumblings in the stomach and bowel

Possible causes of the side effects
The samples of blood, poo and urine taken before starting chemotherapy showed that for:

• 9 out of every 100 people (9%) had a pancreas that wasn’t working well
• 12 out of every 100 people (12%) showed there wasn’t enough vitamin B12 in the blood
• 20 out of every 100 people (20%) had a thyroid gland that wasn’t working very well

The team offered further investigations to find out what might be the cause of the side effects. But people often refused the offer. Even so for every 3 investigations done the team identified 1 treatable cause. In particular these were an:

• overgrowth of bacteria  in the small bowel
• inability to absorb bile
• urine infection

Conclusion
This study shows that bowel symptoms and side effects are common before, during and after chemotherapy. And that they are often treatable. 

They recommend further research through a randomised trial . They suggest offering specialist supportive care to find out:

• what effect this has on how long people lived (survival) 
• how it impacts their quality of life

The team aren’t doing another study. However another research team did a randomised clinical trial and their results were similar to this study’s results.