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Thalidomide May Ease Diarrhea Caused by Chemotherapy

NEW YORK (Reuters Health) - Thalidomide, the drug best known for causing a wave of birth defects in the 1960s, may ease some of the major side effects of a chemotherapy drug used to treat colorectal cancer, preliminary findings suggest.

In the study, 400 milligrams (mg) a day of thalidomide nearly eliminated diarrhea and nausea in nine patients taking the cancer drug irinotecan, according to a report in the August 12th issue of The Lancet.

Irinotecan causes diarrhea in up to 70% of patients. Up to 30% of patients will experience severe diarrhea that requires hospitalization, Dr. Rangaswamy Govindarajan, the study's lead author, told Reuters Health.

``This is a very significant finding'' because side effects are often so severe that doses of the chemotherapy drug are reduced or treatment is stopped entirely, explained Govindarajan, an assistant professor of medicine at the University of Arkansas.

In the study, eight of the nine patients completed treatment.

The team of researchers has launched a phase II study to assess the efficacy of thalidomide and irinotecan in a larger group of patients with colorectal cancer.

Govindarajan said how thalidomide reduces diarrhea and nausea in patients is not known.

About 130,000 new cases of colorectal cancer are diagnosed in the US each year. Colorectal cancers are the third most common cancers diagnosed in both men and women in the US, the American Cancer Society reports.

SOURCE: The Lancet 2000;356:566-567.

When your child has diarrhea, he/she may initially be restricted to clear fluids that are low in sugar (Pedialyte, clear soup broth, PopsicleTM and Jell-OTM). Juice is often not allowed at all or is diluted to one quarter strength because of its high-sugar content (which can actually cause more diarrhea).

Children often have trouble digesting the sugar in milk--lactose--until the diarrhea is gone. Once the diarrhea has slowed and your child is able to take solids, offer milk products low in lactose. The solids should be low in fiber and fat and spices since they may aggravate diarrhea.

Practical Tips

  • Offer small, frequent meals and snacks
  • Offer warm or cool foods. Very hot or very cold foods increase the natural movement of food through the intestines and may aggravate diarrhea
  • Encourage your child to drink to replace the fluids lost with the diarrhea: water, PedialyteTM and in some cases unsweetened Kool-Aid, Jell-O and PopsicleTM frozen treats may be offered.
  • If your child has cramps, do not offer carbonated beverages, dried beans, cabbage, broccoli, cauliflower or chewing gum because they aggravate gas.
  • Try to limit activity for one hour following a meal to allow for better digestion.

What foods should I not offer my child?

High fiber foods:
  • raw fruits (bananas are allowed)
  • dried fruits - e.g., raisins
  • all raw vegetables
  • cooked corn, broccoli, peas, spinach, cauliflower, cabbage
  • legumes (dried peas, beans and lentils)
  • whole grain breads and cereals, bran
  • nuts and seeds, popcorn, granola bars
  • jam with seeds, marmalade

    High fat and spiced foods:
  • fried foods - e.g., French fries, donuts, taco chips, potato chips, fried beef, chicken, fish, pork
  • dishes prepared with pepper, chili powder, paprika, cumin, curry or ginger
  • Margarine, mayonnaise, salad dressings, sauces, gravies, peanut butter,
  • Whipped cheese products and cream cheese are also sources of fat. The dietitian will give you specific guidelines regarding the amount of these products to allow your child.

    High sugar foods:
  • sweets such as candies, chocolate and rich cookies such as cream filled or chocolate chip as well as juice may aggravate diarrhea
  • What foods should I offer my child?

    Fruits/Vegetables:
  • canned fruits and canned or cooked vegetables - e.g., canned applesauce, peaches, pears, apricots, fruit cocktail, baked or mashed potato, carrots, green or yellow beans, asparagus, beets and squash

    Grains:
  • white bread, bagets, buns, crackers with small amount of margarine, smooth peanut butter, jelly
  • lower fiber cereals such as Cheerios®, Rice Krispies®, Corn Flakes®. Avoid bran cereals - check the label on the box
  • plain muffins, blueberry, peach, applesauce muffins
  • rice, pasta with plain sauces - e.g., cheese, tomato, lean meat sauces

    Meat/Alternatives:
  • baked, broiled, barbecued, roasted or steamed beef, fish and skinless chicken, lean ham and pork
  • poached or scrambled eggs, tuna canned in water

    Milk Products:
  • Lactaid® milk (reduced lactaid milk)
  • cream soup, puddings, custards made with Lactaid© milk
  • yogurt eaten with Lactaid® pills
  • hard cheeses such as cheddar, mozzarella

    High potassium foods to offer: (with doctor's approval)
  • Lactaid® treated milk products, red meat, potato, banana, apricots smooth peanut butter, diluted orange juice


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