MASCC recommendations on the management of constipation in patients with advanced cancer

Abstract

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.

The role of GSTM1 gene polymorphism in pathophysiology, evaluation, and management of constipation of anorectal outlet obstruction

“…Many large-scale and small-scale clinical studies have been performed to evaluate whether chronic constipation increases the risk of intestinal cancer (20). The results of these studies are conflicting and some studies show that constipation raises the risk of cancer and other studies conclude that there is no such risk, and some studies have even shown that chronic constipation can reduce the risk (21)(22)(23)(24). Many studies in this area are on people with cancer in comparison with those who do not have cancer.…”

Opioid-induced constipation: a stepwise treatment algorithm feasibility study

“…The treatment algorithm was based on a review of the literature, which was the basis of recent international guidelines. 11 The original sample size was pragmatic (150 participants), which represented 15% of participants in the feeder study, 3 although we were unsure of the prevalence of OIC in the feeder study (as defined by the Rome IV criteria for OIC). It should be noted that the sample size of the feeder study was based on the prevalence of OIC suggested by an Expert Working Group of European Association of Palliative Care.…”

“…International guidelines universally recommend that cancer patients commenced on opioid analgesics should be routinely coprescribed conventional laxatives 9 10 or possibly other treatments to manage constipation. 11 Surprisingly, there is little evidence to support this strategy or indeed to guide the choice of treatment. 11 Even more surprisingly, previous studies have reported frequent non-adherence to these clinical guidelines, 12 and equally lack of adoption/utilisation of new treatments (eg, PAMORAs).…”

“…11 Surprisingly, there is little evidence to support this strategy or indeed to guide the choice of treatment. 11 Even more surprisingly, previous studies have reported frequent non-adherence to these clinical guidelines, 12 and equally lack of adoption/utilisation of new treatments (eg, PAMORAs). 13 The impact of these actions is that constipation/OIC is frequently undertreated in patients with advanced cancer.…”

“…It should be noted that the interventions employed were standard treatments for OIC, with established efficacy and tolerability in this condition. 11 Indeed, no participants were withdrawn Original research due to adverse effects, and there were no reports of unanticipated adverse effects. Other researchers have reported similar results in analogous studies of other symptoms in this population (eg, pain).…”