Secondary impacts of constipation in acute lymphoblastic leukemia in U.S. children's hospitals

Abstract

Background Childrenwith acute lymphoblastic leukemia (ALL) suffer a litany of chemotherapy‐induced side effects. Constipation secondary to vinca alkaloids, psychological stressors, and opioid use are common issues for children newly diagnosed with leukemia. This study investigated the morbidity associated with constipation including infections, mucositis, and healthcare utilization in hospitalized children with ALL receiving induction chemotherapy. Methods We analyzed data from 48 children's hospitals in the Pediatric Health Information System, extracting patients 1–21 years of age with ALL, hospitalized for induction from October 2015 through December 2019. Data were analyzed using nonparametric statistics, and comparisons of outcomes between those with and without constipation were presented as adjusted odds ratios (aOR). Results We identified 2586 (56%) patients with constipation out of a total of 4622 unique ALL patients in induction. Compared to patients without constipation during induction, patients with constipation were significantly more likely to have mucositis (aOR = 2.30; p = 0.0010), perirectal issues (aOR = 3.21; p = 0.0092), or abdominal radiograph exposure (aOR = 2.40; p < 0.0001). The median length of induction hospitalization was significantly greater in those with constipation compared to those without constipation (10 days vs. 8 days; p < 0.0001). Conclusions Children with ALL suffering from constipation during induction therapy have increased length of stay, mucositis, imaging, and overall healthcare utilization compared to children without constipation. Further research should explore the causative relationship between constipation and infections. Increased attention should be given to constipation management in patients with ALL at the start of induction therapy, particularly in patients with complications or prolonged hospitalizations.

Utilization of Discharge Checklist and Improved Education Reduces Hospital Readmission Rates in Childhood Leukemia Patients Receiving Induction Therapy

“…In a multicenter study, constipation was found to be prevalent in 34% of patients during induction, often requiring multiple medications for constipation management 17 . Constipation during induction increases a patient’s risk of having mucositis or perirectal issues 18 . With improved early education and intervention with a daily bowel regimen, we could decrease constipation in our patients with ALL, thereby reducing readmission and health care utilization for treatment-related constipation.…”

“…17 Constipation during induction increases a patient's risk of having mucositis or perirectal issues. 18 With improved early education and intervention with a daily bowel regimen, we could decrease constipation in our patients with ALL, thereby reducing readmission and health care utilization for treatment-related constipation.…”

Comment on: Secondary impacts of constipation in acute lymphoblastic leukemia in US children's hospitals

“…As mentioned by Belsky et al, 1 it can be difficult to attribute the constipation solely to the medication being used. There are a variety of confounding factors that can arise during induction therapy that can also cause constipation-dietary changes due to hospital admission, lack of water intake due to fatigue, and lack of energy to exercise, to name a few.…”

“…We read with great interest, the article by Belsky et al 1 on the effects of constipation in pediatric oncology patients, particularly looking at children who had undergone induction therapy for acute lymphoblastic leukemia (ALL). As medical students who have recently had pediatric and oncology placements, we would like to share our thoughts on what we found to be a fascinating topic.…”

“…Due to side effects, patients can present distressed and require hospital admission, under the guise that it is due to their original condition rather than the treatment. We applaud Belsky et al 1 for including patients who were re-admitted in order to seek psychological support for the side effects of their treatment, as this is a factor often overlooked when looking at re-admission data.…”