Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines

Larkin, Philip; Cherny, N.I.; Carpia, Domenico La; Guglielmo, Mauro; Ostgathe, Christoph; Scotté, Florian; Ripamonti, Carla

doi:10.1093/annonc/mdy148

Cited by 133 publications

(164 citation statements)

References 90 publications

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“…In this regard, the Bowel Function Index (BFI) is one of the most widely recommended tool due to its simplicity and applicability in clinical practice [15,21]. For a more comprehensive evaluation, the BFI may be complemented [12,15]. In this study, 85.2% of the participants cited a healthy lifestyle as fi rst-line treatment but it was considered to be ineffective in 52% of the cases.…”

Section: Discussionmentioning

confidence: 86%

“…Likewise, they are not recommended in cases of paralytic ileus, intestinal obstruction or rectal or anal trauma [12,28].…”

Section: Discussionmentioning

confidence: 99%

“…In Spain the clinical practice guide "Irritable bowel syndrome with constipation and functional constipation in adults" was produced with the participation of different scientifi c societies, and which has already been updated in line with the new Rome IV criteria, but do not addressed OIC management in patients with cancer [11]. The European Society for Medical Oncology (ESMO) has recently published a guide for the management of constipation in patients with cancer [12]. However, the physiopathology of functional constipation and OIC is different and therefore require different approach.…”

Section: Introductionmentioning

confidence: 99%

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Clinical practice evaluation of opioids induced constipation management in patients with cancer: The EIO-50 project

Guillém¹,

Bofill²,

Feyjoo³

et al. 2019

Open J Pain Med

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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 life-style 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. 035 https://www.peertechz.com/journals/open-journal-of-pain-medicine Citation: Guillem V, Salvador Bofill FJ, Feyjoo M, Antón A, Aranda E, et al. (2019) Clinical practice evaluation of opioids induced constipation management in patients with cancer: The EIO-50 project. Open J Pain Med 3(1): 034-040. DOI: https://dx.

show abstract

Section: Discussionmentioning

confidence: 86%

“…Likewise, they are not recommended in cases of paralytic ileus, intestinal obstruction or rectal or anal trauma [12,28].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical practice evaluation of opioids induced constipation management in patients with cancer: The EIO-50 project

Guillém¹,

Bofill²,

Feyjoo³

et al. 2019

Open J Pain Med

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show abstract

“…1 Factors significantly related to the presence of constipation include a diagnosis of cancer, bed restriction and the need for personal assistance for toilet visits. 2 National and European clinical guidelines for the management of constipation for patients receiving palliative care 3,4 identify key clinical messages including an essential comprehensive assessment, ongoing preventive measures, pharmacological and non-pharmacological management strategies of equal importance and particular attention during opioid therapy or in suspected cases of intestinal obstruction.…”

Section: Introductionmentioning

confidence: 99%

‘Take more laxatives was their answer to everything’: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

et al. 2019

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Background: Constipation is a major problem for many older adults, more so for those who are receiving specialist palliative care. However, limited research reports the subjective experiences of constipation, despite evidenced differences between the healthcare professional and patient/carer perspective. Aim: The main aim of this study is to explore the experience of how constipation is assessed and managed within specialist palliative care from the patient, carer and healthcare professional perspective. Design: Exploratory, qualitative design, utilising focus groups and interviews, and analysed using thematic analysis. Setting/participants: Six focus groups with 27 healthcare professionals and semi-structured interviews with 13 patients and 5 family caregivers in specialist palliative care units across three regions of the United Kingdom. Results: Constipation impacted physically, psychologically and socially on patients and families; however, they felt staff relegated it on the list of importance. Lifestyle modifications implemented at home were not incorporated into their specialist palliative care plan within the hospice. Comparatively, healthcare professionals saw constipation solely as a physical symptom. Assessment focused on the physical elements of constipation, and management was pharmacologically driven. Healthcare professionals reported patient embarrassment as a barrier to communicating about bowel care, whereas patients wanted staff to initiate communication and discuss constipation openly. Conclusion: Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this. KeywordsConstipation, symptom management, palliative care, hospice, quality of care, qualitative research

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“…Factors such as lack of privacy when defecating for hospitalized patients, inactivity, or the older age of the patient, also play a role in its occurrence. In cancer patients, in addition to the use of opioids for the treatment of pain, vinca alkaloid-like chemotherapeutic agents produce severe and prolonged neuropathic effects at the gastrointestinal level, which are more severe with vincristine and vindesine, and milder with vinblastine or vinorelbine [16].…”

Section: Introductionmentioning

confidence: 99%

Analysis of care for cancer patients with opioid-induced constipation in clinical practice: EIO-PRAXIS Project

Soler-López¹

2019

Open J Pain Med

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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.

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Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines

Cited by 133 publications

References 90 publications

Clinical practice evaluation of opioids induced constipation management in patients with cancer: The EIO-50 project

Clinical practice evaluation of opioids induced constipation management in patients with cancer: The EIO-50 project

‘Take more laxatives was their answer to everything’: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

Analysis of care for cancer patients with opioid-induced constipation in clinical practice: EIO-PRAXIS Project

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