Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients (original) (raw)
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Open Journal of Pain Medicine, 2019
Introduction: Opioid-Induced Constipation (OIC) is a common distressing symptom associated with cancer pain treatment. Consensus guidelines for management of OIC are limited and little is known about the decision making of Health Care Professionals (HCP) for the management of OIC. The aim of this study was to learn about the diagnostic and treatment criteria of OIC management in clinical practice in patients with cancer. Methods: A survey was designed with 50 OIC specifi c questions and was completed by 135 HCP: 122 medical oncologists (90.4%) and 13 palliative care specialists (9.6%). Result: OIC was considered a relevant side effect by 97% of the specialists. HCP declared differences in the characteristics of OIC depending on whether the patients were treated with major or minor opioids: the percentage of patients developing OIC (54.5% vs 29.8%), OIC intensity (severe in 17% vs 10.8%) and the time to symptoms onset in 1-4 weeks (92.6% vs 73.3%). Only 14% HCP used algorithms for the diagnosis or treatment of OIC. Healthy lifestyle was considered fi rst-line treatment for OIC by 85.2%. Laxatives were prescribed by 99.3% of HCP, but 32.6% of patients did not achieve a response. Peripherally Active μ-Opioid Receptor Antagonists (PAMORAs) were considered the most effective specifi c treatment of OIC. Naloxegol was the PAMORA most often used for the treatment of OIC in patients with cancer. Conclusion: The narrow effectiveness of traditional therapies and the emergence of more effective pharmacological approaches suggest the need for standardized and updated guidelines for OIC diagnosis and management in patients with cancer.
Open Journal of Pain Medicine, 2019
Purpose: The objective of the study was to analyses how Opioid-Induced Constipation (OIC) is managed in cancer patients in clinical practice for comparison against the current recommendations for the management of patients with OIC. Methods/Patients: A retrospective observational study was designed with pooled data from the review of clinical histories of cancer patients who received treatment with opioids and developed OIC according to the Rome IV criteria. Clinical histories were prior to 1 March 2018. The Scientifi c Committee of the study selected structure, process and outcome indicators related to the diagnosis and treatment of patients with OIC. Results: The project involved 77 oncologists from 26 Spanish provinces, who included information on 770 patients. A total of 96.1% were from public hospitals. No protocols for the management of patients with OIC were available in 89.6% of sites. The patients included in the study had a mean age of 61.6 years. Functional constipation was assessed before opioid administration in 62.8% of patients. OIC was Grade 2 in 46.4%, Grade 1 in 33.4%, Grade 3 in 18.9%, and Grade 4 in 1.3%. Laxatives were prescribed as fi rstline treatment, and were administered to 77.6% of patients. Oral PAMORAs (Peripherally Active μ-Opioid Receptor Antagonists) without laxatives were administered to 29.6% of patients. Conclusions: Although no protocols for the management of cancer patients with OIC were available in a large percentage of sites, compliance with current recommendations was considered adequate and consistent with the group of cancer patients in clinical practice.
Open Journal of Nursing, 2018
Background: To reduce patients' unnecessary suffering, Opioids Induced Constipation (OIC) should be identified and treated as early as possible with the most current treatment. Aims: to investigate the effectiveness of prophylactic laxatives in reducing the severity of OIC and its impact on cancer patients' quality of life. Methods: A Randomized Clinical Trial design was used. 57 cancer patients from one oncology clinic at a governmental hospital participated in the study. Patients in the intervention groups were given an oral colonic stimulant laxative (i.e. Bisacodyl, Dose = 3 tab/day) or an oral colonic osmotic laxative (i.e. Lactulose, Dose = 15 ml three times per day), while patients in the control continue receiving their routine care as usual. Results: A significant decrease in the severity of constipation symptoms among the intervention group at four weeks post-intervention was noted (p < 0.001). In addition, there was a significant improvement in QOL among patients in the intervention group (p < 0.001) and no significant difference in the control group (p = 0.887). Conclusions: It can be concluded that the use prophylactic of first line laxatives concurrently with opioids decreased the severity of OIC and improved the QOL for cancer patients.
Opioid-Induced Constipation among a Convenience Sample of Patients with Cancer Pain
Frontiers in Oncology, 2016
Background: Little is known regarding the burden of opioid-induced constipation (OIC) among patients who suffer from cancer-related pain. Methods: A prospective longitudinal study was conducted among cancer patients in the United Kingdom (UK), Canada, and Germany, which included medical record data abstraction, Internet-based patient surveys, and physician surveys. Patients on daily opioid therapy (≥30 mg for ≥4 weeks) for treatment of cancer pain with self-reported OIC were recruited. Response to laxatives was defined by classifying participants into categories of laxative use and evaluating the prevalence of inadequate response. Descriptive statistics were used to evaluate outcomes, including the patient assessment of constipation-symptom (PAC-SYM), patient assessment of constipation-quality of life, EuroQOL-5 dimensions, and global assessment of treatment benefit, satisfaction, and willingness to continue. results: Recruitment was difficult for this study with only 31 participants completing the baseline survey and meeting criteria for opioid use and OIC (26 UK, 1 Canada, and 4 Germany). Fifty-two percent (n = 16) of participants were male, and all were White. Breast (23%, n = 7), pancreatic (13%, n = 4), and multiple myeloma (13%, n = 4) were the most common cancers. Mean duration of chronic pain and opioid use were 2.3 and 1.3 years, respectively. Participants reported having a mean of 4.4 bowel movements/ week in the 2 weeks prior to baseline, of which a mean of 0.9 were spontaneous. Most participants (90%, n = 28) were using at least 1 lifestyle approach to manage their constipation; 65% (n = 20) were taking ≥1 over-the-counter laxative; 19% (n = 6) were taking ≥1 prescription laxative; 23% (n = 7) reported no laxative use in the prior 2 weeks. Moderate-to-severe constipation symptoms on the PAC-SYM were common, and mean scores on health-related quality of life outcomes were comparable to chronic pain populations. conclusion: In this primarily UK sample, there appears to be considerable unmet OIC treatment needs among cancer patients.
Supportive Care in Cancer, 2012
Purpose This study aimed to evaluate the bowel habit and laxative use in advanced cancer patients with constipation in palliative care unit. Methods It was a cross-sectional study using a self-designed questionnaire. Results A total of 225 patients were analysed. Among all patients, 92.0 % (207 patients) had any intervention for relief of constipation, including laxatives, suppositories, enemas, digital evacuation and Chinese herbal medicine, and 65.3 % (147 patients) were on laxatives prescribed by our doctors. The severity of constipation as assessed by the constipation visual analogue scale (CVAS) (0-7, 70most severe) was reported as no constipation (0-1) in 19.6 % of patients, constipation (2-4) in 50.7 % and severe constipation (5-7) in 29.8 %. More patients with severe constipation, as compared with patients with constipation and no constipation, reported inadequate pushing force (83.6 vs. 47.4 vs. 6.8 %), sense of incomplete defecation (40.3 vs. 14.9 vs. 6.8 %) and difficult defecation (58.2 vs. 26.3 vs. 0 %), all p<0.001, but there was no difference in stool types as assessed by Bristol Stool Scale (p00.303). Patients not on opioids, as compared with patients on strong opioids, had similar CVAS scores and description of constipation but had least laxatives prescribed (60.2 vs. 78.9 %, p00.012). Conclusion Evaluation of constipation should not rely on stool form or consistency alone, and patient's description of constipation is worth consideration. Constipation is also a problem in patients not on opioids and more attention is required. A revisit to existing guidelines is needed.
Asian Pacific Journal of Cancer Prevention
Cancer is considered one of the most common health problems worldwide (Dascălu et al., 2022; Siegel et al., 2015). Many studies have shown that patients with cancer usually suffer from pain and need to use opioids (Azizoddin et al., 2021; Chou et al., 2009; Mercadante, 2014; Mohammad and Ahmad, 2019). Despite the analgesic effects of opioids, these drugs have many adverse effects, such as constipation, loss of appetite, vomiting, urinary alterations, and may cause an alteration in cognitive ability (Daoust et al., 2020; Els et al., 2017). Constipation caused by opioid therapy is considered as one of the most common bothering symptoms among patients with cancer (Larkin et al., 2018; Mesía et al., 2019); and it is considered by many patients as more severe than cancer pain itself (Dhingra et al., 2013; Larkin et al., 2018). The reported incidence of opioid-induced constipation (OIC) in the previous studies was varied from 22% to 81% based on the study sample size (Abramowitz et al., 2013; Ducrotté et al., 2017). Opioid-induced constipation has a negative impact on patients' quality of life (QoL) and comfort level (Bell Abstract Background: Prophylactic laxatives were associated with decreasing the incidence of Opioid-induced constipation among patients with cancer. This study aims to evaluate the effectiveness of early prophylactic laxatives therapy on the severity of constipation and quality of life among patients with cancer receiving opioids. Methods: Using a quasiexperimental design with 64 patients assigned to control group and 66 patients assigned to intervention group. The final sample was composed from 112 patients (57 in control group and 55 in intervention group), who were selected from an oncology clinic. Patients in the intervention group have received prophylactical laxatives The intervention included an oral colonic stimulant laxative (i.e., Bisacodyl, Dose= 3 tab/ day and/or Senna 6.8 mg twice daily) and an oral colonic osmotic laxative (i.e., Lactulose, Dose = 15 ml three times per day). Patients in the control group continue to receive their routine care without laxatives. Results: Patients in the intervention group have reported a significant reduction in the severity of constipation symptoms at eight weeks post the intervention (p < 0.001). Furthermore, the patients in the intervention group have revealed a significant improvement in their quality of life (QoL) (p< 0.001). Conclusions: Patients with cancer need to use the first line of laxatives as prophylactic alongside with opioids to minimize the severity of Opioid-induced constipation symptoms and to enhance the QoL.
BMJ Supportive & Palliative Care, 2021
ObjectivesNaloxegol is a peripherally acting µ-opioid receptor antagonist (PAMORA) for treatment of opioid-induced constipation (OIC). The main objective was to analyse the long-term efficacy, quality of life (QOL) and safety of naloxegol in patients with cancer in a real-world study.MethodsThis one-year prospective study included patients older than 18 years, with active oncological disease who were under treatment with opioids for pain control and Karnofsky≥50 and OIC with inadequate response to treatment with laxative (s). All the patients received treatment with naloxegol according to clinical criteria. The main efficacy objectives were measured by the patient assessment of constipation QOL questionnaire (PAC-QOL), the PAC symptoms (PAC-SYM), the response rate at day 15, and months 1-3-6-12, and global QOL (EuroQoL-5D-5L).ResultsA total of 126 patients (58.7% males) with a mean age of 61.5 years (95% CI 59.4 to 63.7) were included. PAC-SYM and PAC-QOL total score and all their d...
Evidence-based management of constipation in the oncology patient
European Journal of Oncology Nursing, 2001
Constipation is suffered by over 50% of cancer patients and is regarded as one of the most distressing symptoms causing both physical and emotional distress. A need to treat constipation is often due to a failure to prevent it.There is little literature in this area and research based on clinical trials as to best treatment is virtually non-existent. It is suggested that many health-care professionals dismiss constipation as a relatively trivial problem, resulting in a lack of attention to the subject.There is a lack of consensus on the def|nition of constipation and confusion regarding effective methods for prevention and treatment. It could be argued that health-care professionals are more intent on monitoring the direct effects rather than the secondary effects of treatment. Since constipation is largely preventable, there is a need to highlight the importance of prevention in addition to establishing effective treatment guidelines.Oncology nurses are in an ideal position to identify cancer patients in a high-risk category and utilize preventive strategies.The study described has led to the development of evidence-based drug guidelines to be used in the prevention of constipation and acute/chronic constipation to ensure that patients receive the best treatment possible.
MASCC recommendations on the management of constipation in patients with advanced cancer
Supportive Care in Cancer, 2019
Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer Methods: These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews / trials respectively. The recommendations were categorised by the level of evidence, and a "category of guideline" based on the level of evidence (i.e. "recommendation", "suggestion", or "no guideline possible") Results: The Group produced 15 recommendations, with varying levels of evidence, and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. Conclusions: These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.