80 Participants Needed

Bowel Management Program for Colorectal Cancer

TO
Overseen ByThe Ohio State Comprehensive Cancer Center
Age: 18+
Sex: Any
Trial Phase: Phase < 1
Sponsor: Ohio State University Comprehensive Cancer Center
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

Do I need to stop my current medications for the trial?

The trial protocol does not specify if you need to stop your current medications. It might be best to discuss this with the research team or your doctor.

Is the retrograde rectal enema safe for humans?

Research on retrograde colonic irrigation, which is similar to retrograde rectal enema, has been conducted for conditions like fecal incontinence after rectal surgery. While specific safety data for colorectal cancer is not detailed, the procedure is generally used in medical settings, suggesting it is considered safe for human use in certain conditions.12345

How does the treatment Retrograde Rectal Enema differ from other treatments for colorectal cancer?

The Retrograde Rectal Enema is unique because it involves administering a solution directly into the rectum to manage bowel function, which is different from standard treatments like surgery or chemotherapy that target cancer cells directly. This method may help improve bowel management specifically, which is not typically the focus of other colorectal cancer treatments.678910

What is the purpose of this trial?

This clinical trial studies if a bowel management program with a retrograde rectal enema (RRE) for the treatment of low anterior resection syndrome (LARS) in rectal cancer patients is better than medical management alone. Rectal cancer treatment can include a procedure where part of the rectum with cancer is removed and the remaining part of the rectum is reconnected to the colon, this is called a low anterior resection of the rectum. LARS is a common condition that can develop after undergoing a low anterior resection of the rectum. LARS consists of any change in how the body performs defecation, the discharge of feces from the body, after undergoing a resection procedure. Patients with LARS may experience fecal urgency, incontinence, increased frequency, constipation, feelings of incomplete bowel movement, or bowel emptying difficulties. Patients may experience individual symptoms of LARS or a combination of them. A bowel management program assists patient's with identifying a specific bowel management regimen that works best for managing symptoms of LARS. A RRE consists of inserting a catheter through the anus into the rectum. The RRE is designed to assist fecal emptying. Medical management of LARS can include the use of fiber, loperamide hydrochloride, or pelvic floor physical therapy. Fiber may help relieve constipation, feelings of incomplete bowel movement, or bowel emptying difficulties. Loperamide hydrocholoride may help lessen fecal urgency, incontinence, or increased frequency. Pelvic floor physical therapy may help restore strength in the rectum possibly helping to improve symptoms of LARS. Participating in a bowel management program with a RRE may be more effective in treating LARS than medical management alone.

Research Team

AC

Alessandra C Gasior, DO

Principal Investigator

Ohio State University Comprehensive Cancer Center

Eligibility Criteria

This trial is for rectal cancer patients who have undergone a low anterior resection and are now experiencing LARS, which includes symptoms like fecal urgency, incontinence, constipation, or difficulty emptying the bowel. The study seeks individuals struggling with these post-surgery changes to their bowel habits.

Inclusion Criteria

I have been diagnosed with LARS.
I have a history of rectal cancer.

Exclusion Criteria

My colorectal cancer has come back.
I am under 18 years old.
Active sacral nerve simulator
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Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a bowel management program with either RRE and medical management or medical management alone for 1 year

52 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 year
Follow-up visits at 1 month, 3 months, and 1 year

Treatment Details

Interventions

  • Retrograde Rectal Enema
Trial Overview The study is testing if a bowel management program using retrograde rectal enemas (RRE) can better manage LARS symptoms compared to standard medical treatments alone. This involves inserting a catheter into the rectum to help with fecal emptying alongside dietary adjustments, medication like loperamide hydrochloride, and physical therapy.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Group I (RRE, medical management)Experimental Treatment6 Interventions
Patients undergo a bowel management program comprising a medical management pathway (fiber, loperamide hydrochloride, pelvic floor physical therapy) in combination with RRE treatment for 1 year. Patients use the RRE system to self administer an individualized enema regimen via the rectum. Patients may undergo abdominal film x-rays throughout the trial.
Group II: Group II (medical management)Active Control4 Interventions
Patients receive medical management comprising fiber, loperamide hydrochloride, and pelvic floor therapy for 1 year. If medical management fails, patients may then be referred for surgery with sacral nerve stimulator placement.

Find a Clinic Near You

Who Is Running the Clinical Trial?

Ohio State University Comprehensive Cancer Center

Lead Sponsor

Trials
350
Recruited
295,000+

Findings from Research

In a study of 46,692 elderly colorectal cancer patients, those receiving intravenous chemotherapy experienced significantly higher rates of adverse events, particularly with oxaliplatin-based regimens, which caused more nausea, neutropenia, and neuropathy compared to fluorouracil alone.
Patients aged 70 and older were more likely to suffer from adverse effects such as infection, anemia, delirium, and heart disease, highlighting the need for careful patient selection and support when administering chemotherapy to older adults.
Comparison of toxicity profiles of fluorouracil versus oxaliplatin regimens in a large population-based cohort of elderly patients with colorectal cancer.Cen, P., Liu, C., Du, XL.[2020]

References

Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol. [2021]
Retrograde colonic irrigation for faecal incontinence after low anterior resection. [2021]
Safety and efficacy of an "enhanced recovery after surgery" protocol for patients undergoing colon cancer surgery: a multi-institutional controlled study. [2018]
The role of the retrograde colonic enema in children with spina bifida: is it inferior to the antegrade continence enema? [2021]
Comparison of toxicity profiles of fluorouracil versus oxaliplatin regimens in a large population-based cohort of elderly patients with colorectal cancer. [2020]
Personalized surgical management of colorectal cancer in elderly population. [2022]
Implementation of a Synoptic Operative Report for Rectal Cancer: A Mixed-Methods Study. [2021]
Enhanced recovery after surgery efficacy in an older patients and high-risk population affected by colorectal cancer: a more than 1000 patients experience. [2020]
Feasibility and outcomes of ERAS protocol in elective cT4 colorectal cancer patients: results from a single-center retrospective cohort study. [2021]
[Application of enteral nutrition in preoperative bowel preparation for rectal cancer patients undergoing radical operation]. [2018]
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