Document Type : Original Article(s)

Authors

1 Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran

2 Department of Medical Oncology and Hematology, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran

3 Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Chemotherapy-related diarrhea reduces patients' quality of life and sometimes changes or interrupts their treatment regimen. This study aimed to evaluate the effect of yogurt with probiotics on diarrhea caused by chemotherapy.
Method: The present study was a randomized controlled clinical trial. The sample consisted of 66 patients with colorectal cancer, recruited with convenience sampling method from patients who were referred to Buali Hospital of Tehran. The samples were randomly divided into three groups. The first group received yogurt with probiotics, the second group received yogurt alone, and the third group of control did not use yogurt during treatment. Data were gathered using the diarrhea section of adverse events. The number of defecations, the severity of diarrhea, and the consistency of stool in the seven days of the intervention were compared among the three groups. Analysis of variance and Tukey's post hoc test were performed through SPSS software.
Results: The number of defecations in the yogurt group with probiotics and yogurt was significantly lower than the control group (P < 0.05). The severity of diarrhea in the yogurt group with probiotics decreased more rapidly (P < 0.05). Stool consistency in the yogurt group with probiotics was significantly better than the control group (P < 0.05).
Conclusion: Based on the results of the present study, yogurt with probiotics can reduce and improve diarrhea caused by chemotherapy. The results also showed that yogurt alone can reduce diarrhea and improve its symptoms.

Keywords

How to cite this article:

Mohebian F, Mohammadzadeh Zarankesh S, Jenabian A, Ranjbar H. The effectiveness of yogurt+ probiotic on chemotherapy-related diarrhea in patients with colorectal cancer: A randomized clinical trial. Middle East J Cancer. 2023;14(1):127-35. doi: 10. 30476/mejc.2021.91324.1620.

  1. Tanaka A, Wang JY, Shia J, Zhou Y, Ogawa M, Hendrickson RC, et al. Maspin as a prognostic marker for early stage colorectal cancer with microsatellite instability. Front Oncol. 2020;10:945. doi: 10.3389/fonc.2020.00945.
  2. Veettil SK, Lim KG, Chaiyakunapruk N, Ching SM, Abu Hassan MR. Colorectal cancer in Malaysia: Its burden and implications for a multiethnic country. Asian J Surg. 2017;40(6):481-9. doi: 10.1016/ j.asjsur.2016.07.005.
  3. Florea A, Sangare L, Lowe K. A Multinational assessment of gastric, esophageal, and colorectal cancer burden: A report of disease incidence, prevalence, and fatality. J Gastrointest Cancer. 2020;51(3):965-71. doi: 10.1007/s12029-019-00328-4.
  4. Navarro M, Nicolas A, Ferrandez A, Lanas A. Colorectal cancer population screening programs worldwide in 2016: An update. World J Gastroenterol. 2017;23(20):3632-42. doi: 10.3748/wjg.v23.i20.3632.
  5. Tan KK, Koh GCH. Could spouses of colorectal cancer patients possess higher risk of developing colorectal cancer? Int J Colorectal Dis. 2018;33(3):353. doi: 10.1007/s00384-018-2966-1.
  6. Nurhesti POY, Adiputra INJEC. Assessment and management of cancer-related fatigue: Health care providers’ perceptions. Enferm Clin. 2020;30:86-9. doi: 10.1016/j.enfcli.2020.07.018.
  7. García-Aranda M, Téllez T, Muñoz M, Redondo MJAcd. Clusterin inhibition mediates sensitivity to chemotherapy and radiotherapy in human cancer. Anticancer Drugs. 2017;28(7):702-16. doi: 10.1097/CAD.0000000000000507.
  8. Devlin EJ, Denson LA, Whitford HS. Cancer treatment side effects: A meta-analysis of the relationship between response expectancies and experience. J Pain Symptom Manage. 2017;54(2):245-58.e2. doi: 10.1016/j. jpainsymman.2017.03.017.
  9. Nurgali K, Jagoe RT, Abalo R. Editorial: Adverse effects of cancer chemotherapy: Anything new to improve tolerance and reduce sequelae? Front Pharmacol. 2018;9:245. doi: 10.3389/fphar.2018. 00245.
  10. Wang J, Feng W, Zhang S, Chen L, Tang F, Sheng Y, et al. Gut microbial modulation in the treatment of chemotherapy-induced diarrhea with Shenzhu Capsule. BMC Complement Altern Med. 2019;19(1):126. doi: 10.1186/s12906-019-2548-y.
  11. Fei Z, Lijuan Y, Xi Y, Wei W, Jing Z, Miao D, et al. Gut microbiome associated with chemotherapy-induced diarrhea from the CapeOX regimen as adjuvant chemotherapy in resected stage III colorectal cancer. Gut Pathog. 2019;11(1):18. doi: 10.1186/s13099-019- 0299-4.
  12. Thomsen M, Vitetta L. Adjunctive treatments for the prevention of chemotherapy- and radiotherapy-induced mucositis. Integr Cancer Ther. 2018;17(4):1027-47. doi: 10.1177/1534735418794885.
  13. Tarricone R, Abu Koush D, Nyanzi-Wakholi B, Medina-Lara A. A systematic literature review of the economic implications of chemotherapy-induced diarrhea and its impact on quality of life. Crit Rev Oncol Hematol. 2016;99:37-48. doi: 10.1016/j. critrevonc.2015.12.012.
  14. Arora N, Gupta A, Singh PPJJogo. Biological agents in gastrointestinal cancers: adverse effects and their management. J Gastrointest Oncol. 2017;8(3):485. doi: 10.21037/jgo.2017.01.07.
  15. Wang J, Feng W, Zhang S, Chen L, Sheng Y, Tang F, et al. Ameliorative effect of Atractylodes macrocephala essential oil combined with Panax ginseng total saponins on 5-fluorouracil induced diarrhea is associated with gut microbial modulation. J Ethnopharmacol. 2019;238:111887. doi: 10.1016/j.jep.2019.111887.
  16. Parikh P, Prabhash K, Naik R, Vaid AK, Goswami C, Rajappa S, et al. Practical recommendation for rash and diarrhea management in Indian patients treated with tyrosine kinase inhibitors for the treatment of non-small cell lung cancer. Indian J Cancer. 2016;53(1):87-91. doi: 10.4103/0019-509X.180863.
  17. Krishnamurthi SS, Macaron C. Management of acute chemotherapy-related diarrhea 2019. [ Internet] [cited at: Apr 05, 2021]. Available from: https://www. uptodate.com/contents/management-of-acutechemotherapy- related-diarrhea
  18. Sawh SC, Deshpande S, Jansen S, Reynaert CJ, Jones PM. Prevention of necrotizing enterocolitis with probiotics: a systematic review and meta-analysis. PeerJ. 2016;4:e2429. doi: 10.7717/peerj.2429.
  19. Parker EA, Roy T, D'Adamo CR, Wieland LS. Probiotics and gastrointestinal conditions: An overview of evidence from the Cochrane Collaboration. Nutrition. 2018;45:125-34 e11. doi: 10.1016/j.nut .2017.06.024.
  20. Wilkins T, Sequoia J. Probiotics for gastrointestinal conditions: A summary of the evidence. Am Fam Physician. 2017;96(3):170-8.
  21. Kong C, Gao R, Yan X, Huang L, Qin H. Probiotics improve gut microbiota dysbiosis in obese mice fed a high-fat or high-sucrose diet. Nutrition. 2019;60:175- 84. doi: 10.1016/j.nut.2018.10.002.
  22. Harper A, Naghibi MM, Garcha D. The role of bacteria, probiotics and diet in irritable bowel syndrome. Foods. 2018;7(2). doi: 10.3390/foods7020013.
  23. Abd El-Atti S, Wasicek K, Mark S, Hegazi R. Use of probiotics in the management of chemotherapy-induced diarrhea: a case study. JPEN J Parenter Enteral Nutr. 2009;33(5):569-70. doi: 10.1177/0148607109332004.
  24. Lu D, Yan J, Liu F, Ding P, Chen B, Lu Y, et al. Probiotics in preventing and treating chemotherapyinduced diarrhea: a meta-analysis. Asia Pac J Clin Nutr. 2019;28(4):701-10. doi: 10.6133/apjcn. 201912_28(4).0005.
  25. Wang YH, Yao N, Wei KK, Jiang L, Hanif S, Wang ZX, et al. 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. Eur J Clin Nutr. 2016;70(11):1246-53. doi: 10.1038/ejcn.2016.102.
  26. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044-60. doi: 10.1111/apt.15001.
  27. Hassan H, Rompola M, Glaser AW, Kinsey SE, Phillips RS. Systematic review and meta-analysis investigating the efficacy and safety of probiotics in people with cancer. Support Care Cancer. 2018;26(8):2503-9. doi: 10.1007/s00520-018-4216-z.
  28. Mansouri-Tehrani Hs, Rabbani Khorasgani M, Roayaei M. Effects of probiotics with or without honey on radiation-induced diarrhea. Int J Radiat Res. 2016;14(3):205-13. doi: 10.18869/acadpub.ijrr. 14.3.205.
  29. Lin S, Shen Y. 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 based on 23 randomized studies. Int J Surg. 2020;84:69-77. doi: 10.1016/j.ijsu.2020.10.012.
  30. He JD, Kong C, Gao RY, Yin F, Zhang Y, Qin HL. Effects of probiotics on the intestinal microecological abnormalities and colorectal cancer of mice induced by high-fat diet. [Article in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. 2020;23(Z1):77-85. doi: 10.3760/cma.j.cn.441530-20200417-00223.
  31. Keshari S, Balasubramaniam A, Myagmardoloonjin B, Herr DR, Negari IP, Huang CM. Butyric acid from probiotic staphylococcus epidermidis in the skin microbiome down-regulates the ultraviolet-induced pro-inflammatory IL-6 cytokine via short-chain fatty acid receptor. Int J Mol Sci. 2019;20(18). doi: 10.3390/ijms20184477.
  32. Quaresma M, Damasceno S, Monteiro C, Lima F, Mendes T, Lima M, et al. Probiotic mixture containing Lactobacillus spp. and Bifidobacterium spp. attenuates 5-fluorouracil-induced intestinal mucositis in mice. Nutr Cancer. 2020;72(8):1355-65. doi: 10.1080/01635581.2019.1675719.
  33. Tang Y, Wu Y, Huang Z, Dong W, Deng Y, Wang F, et al. Administration of probiotic mixture DM#1 ameliorated 5-fluorouracil-induced intestinal mucositis and dysbiosis in rats. Nutrition. 2017;33:96-104. doi: 10.1016/j.nut.2016.05.003.
  34. Chua LL, Rajasuriar R, Azanan MS, Abdullah NK, Tang MS, Lee SC, et al. Reduced microbial diversity in adult survivors of childhood acute lymphoblastic leukemia and microbial associations with increased immune activation. Microbiome. 2017;5(1):35. doi: 10.1186/s40168-017-0250-1.
  35. Zuccaro V, Lombardi A, Asperges E, Sacchi P, Marone P, Gazzola A, et al. The possible role of gut microbiota and microbial translocation profiling during chemofree treatment of lymphoid malignancies. Int J Mol Sci. 2019;20(7). doi: 10.3390/ijms20071748.
  36. McQuade RM, Stojanovska V, Abalo R, Bornstein JC, Nurgali K. Chemotherapy-induced constipation and diarrhea: Pathophysiology, current and emerging treatments. Front Pharmacol. 2016;7:414. doi: 10.3389/fphar.2016.00414.
  37. Miller, AC, Elamin, EM. Use of probiotics for treatment of chemotherapy-induced diarrhea: is it a myth? JPEN J Parenter Enteral Nutr. 2009;33(5):573-4. doi.org/10.1177/0148607109336596.
  38. Velasco M, Requena T, Delgado-Iribarren A, Pelaez C, Guijarro C. Probiotic yogurt for the prevention of antibiotic-associated diarrhea in adults: A randomized double-blind placebo-controlled trial. J Clin Gastroenterol. 2019;53(10):717-23. doi: 10.1097/ MCG.0000000000001131.
  39. Donovan SM, Rao G. Health benefits of yogurt among infants and toddlers aged 4 to 24 months: a systematic review. Nutr Rev. 2019;77(7):478-86. doi: 10.1093/nutrit/nuz009.