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A systematic review of the effectiveness of palliative interventions to treat rectal tenesmus in cancer

Ní Laoire, Áine; Fettes, Lucy; Murtagh, Fliss E.M.

Authors

Áine Ní Laoire

Lucy Fettes



Abstract

Background:
Rectal tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of tenesmus in this patient population.

Aim:
To identify and examine the effectiveness of interventions to palliate rectal tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options.

Design:
A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.

Data sources:
A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from date of inception to April 2016. PubMed ‘related articles’ search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat tenesmus were excluded. Studies involving interventions to treat pelvic pain syndromes without specific outcome measures on severity of tenesmus were excluded. The quality of the studies was assessed using a National Institute for Health and Clinical Excellence–recommended quality assessment tool.

Results:
From 861 studies, 9 met full criteria and were selected. All were case series investigating the use of pharmacological interventions (diltiazem, nifedipine, methadone, mexiletine hydrochloride, lidocaine and bupivacaine), anaesthetic interventions (lumbar sympathectomy, neurolytic superior hypogastric plexus block), and endoscopic laser interventions. The included studies showed substantial heterogeneity, and therefore, a meta-analysis was not feasible.

Conclusion:
From this review, we identified a significant gap in research into the palliation of rectal tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of tenesmus. Future research should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series.

Journal Article Type Review
Publication Date Dec 1, 2017
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 31
Issue 10
Pages 975-981
APA6 Citation Ní Laoire, Á., Fettes, L., & Murtagh, F. E. (2017). A systematic review of the effectiveness of palliative interventions to treat rectal tenesmus in cancer. Palliative medicine, 31(10), 975-981. https://doi.org/10.1177/0269216317697897
DOI https://doi.org/10.1177/0269216317697897
Keywords Rectum; Pain; Neoplasm; Palliative care; Systematic review
Publisher URL http://journals.sagepub.com/doi/10.1177/0269216317697897
Copyright Statement © The Author(s) 2017. Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0)
Additional Information Copy of article first published in: Palliative medicine, 2017, v.31, issue 10.

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Copyright Statement
© The Author(s) 2017. Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0)





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