Expert Opinion

BRAT Diet

for Chemotherapy-Induced Diarrhea

The BRAT diet is a bland food diet consisting of bananas, rice, applesauce, and toast that may be recommended to adults and children for an upset stomach and diarrhea. The BRAT diet has been suggested for the management of diarrhea in patients with chemotherapy-induced diarrhea.

Guideline / Expert Opinion

National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Palliative care [v.1.2016]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/palliative.pdf

Purpose & Patient Population

PURPOSE: To provide guidance to clinicians regarding the provision of palliative care
 
TYPES OF PATIENTS ADDRESSED: Patients with cancer

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline

PROCESS OF DEVELOPMENT: Guidelines were developed by a panel

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Palliative care 

Results Provided in the Reference

These guidelines did not provide a specific search strategy or information about literature search results.

Guidelines & Recommendations

  • Dyspnea: Use fans, cooler temperatures, stress management, and relaxation therapy; use morphine if the patient is opioid-naïve, and add benzodiazepines symptoms are not relieved by opioids; give oxygen for subjective relief; reduce excessive secretions with scopolamine, atropine ophthalmic solution, or glcopyrrolate.
  • Anorexia: Consider an appetite stimulant such as megestrol acetate, olanzapine, dexamethasone, or a cannabinoid.
  • Constipation: Use senna with or without docusate; add other laxatives as needed; consider methylnaltrexone for opioid-induced constipation.
  • Diarrhea: Administer loperamide; recommend the Bananas, Rice, Applesauce and Toast (BRAT) diet; consider atropine, corticosteroids, infliximab, or octreotide.

Limitations

These recommendations were made mainly by consensus, and the guidelines provided no information about literature search results and appeared to use only one database for searching. All suggestions were based on low-level evidence and uniform consensus.

Nursing Implications

These guidelines provided numerous suggestions for the management of various symptoms, but they were not truly evidence-based. In those aspects for which there was no research evidence, the guidelines provided expert opinion suggestions for management.

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