Wang, Y.H., Yao, N., Wei, K.K., Jiang, L., Hanif, S., Wang, Z.X., & Pei, C.X. (2016). The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: A systematic review and meta-analysis. European Journal of Clinical Nutrition, 70, 1246–1253. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the effects of probiotics for the prevention of diarrhea in patients receiving chemoradiotherapy for cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Cochrane Library, PubMed, EMBASE, and Web of Science up until to November 2015
 
INCLUSION CRITERIA: Patients with abdominal or pelvic cancer receiving chemotherapy, radiotherapy, or both; randomized, controlled trials (RCTs) or non-RCTs. Adverse events of probiotics were reported, and incidence of diarrhea was given.
 
EXCLUSION CRITERIA: Nonplacebo-controlled trials

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 916
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane risk of bias tool was used to evaluate study quality. For safety analysis, detecting the adverse event definition and reporting bias were used.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 9 placebo controlled studies for assessing efficacy, 11 studies for assessing safety
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,265 patients for efficacy analysis, 1,612 for safety analysis
  • SAMPLE RANGE ACROSS STUDIES: 24–490 patients for efficacy

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

  • Six RCTs looked at frequency of diarrhea at grade 2 or lower. No significant differences in this level of diarrhea existed with probiotics. For diarrhea greater than grade 2 (four studies), the odds ratio (OR) was 0.36 (p < 0.001) in favor of probiotics compared to placebo.
  • For chemotherapy-induced (seven studies), the overall OR was 0.48 (95% confidence interval [CI] [0.27, 0.85], p = 0.01) with high heterogeneity.
  • For radiation-induced (two studies), the overall OR was 0.47 (95% CI [0.28, 0.76], p = 0.002) with high heterogeneity.
  • Variation existed across studies in the use of antidiarrheal medications.
  • No adverse events caused by probiotics were reported in seven studies, and four studies reported varying degree adverse events. Reporting of adverse events was insufficient to allow for pooled analysis. 
  • Studies used differing combinations of probiotics

Conclusions

Probiotics may have a role in the prevention or management of chemotherapy- and radiotherapy-induced diarrhea. The risk of probiotic-associated infections is unclear.

Limitations

  • High heterogeneity
  • Low sample sizes
  • Many studies had very small samples.  
  • Varying risk of bias among studies included
  • Varied combinations of probiotics were studied.

Nursing Implications

Probiotics may have a role in the prevention and management of chemotherapy- and radiotherapy-induced diarrhea; however, studies have used different probiotic combinations, and the best combination is unclear. Infection-related risks are unclear, but some associated infections have been reported. Caution should be used in patients who are severely immunocompromised.

Legacy ID

6212