Clinical use of oral laxatives in palliative care services in Spain

Noguera, Antonio Vercher; Centeno, Carlos; Librada, Silvia; Nabal, María

doi:10.1007/s00520-010-0956-0

Cited by 9 publications

(3 citation statements)

References 15 publications

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“…volume of fluid, taste / consistency), as well as certain adverse effects (e.g. diarrhoea, abdominal distension) [2]. The same considerations apply to all other conventional laxatives (and indeed all interventions for constipation).…”

Section: Recommendation 6 -Conventional Laxatives Should Be Considerementioning

confidence: 94%

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

Davies

Leach

Caponero

et al. 2019

Support Care Cancer

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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.

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Section: Recommendation 6 -Conventional Laxatives Should Be Considerementioning

confidence: 94%

“…The reasons for the latter are multiple, and include inadequate assessment, inappropriate treatment, and inadequate re-assessment (and assess response to treatment). Moreover, non-adherence to clinical guidelines [2], and non-adoption of new interventions [3], appear to be common occurrences.…”

Section: Introductionmentioning

confidence: 99%

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

Davies

Leach

Caponero

et al. 2019

Support Care Cancer

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“…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.…”

Section: What Is Their Significance?mentioning

confidence: 99%

Opioid-induced constipation: a stepwise treatment algorithm feasibility study

Davies

Leach

Butler

et al. 2021

BMJ Support Palliat Care

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BackgroundOpioid-induced constipation (OIC) is frequently undertreated in patients with advanced cancer. Our hypothesis is that the use of a stepwise treatment algorithm, supported by regular patient-reported outcome measures, should improve the management of OIC. The aim of this feasibility study was to determine whether a definitive study could be successfully completed.MethodsPatients with OIC (Rome Foundation diagnostic criteria positive), and a Bowel Function Index (BFI) score of ≥30, were recruited to the study. The study involved weekly assessments, and decisions about management were based on the current BFI score (and the tolerability of the current treatment). Management was based on a four-step treatment algorithm, developed from recent international guidelines.ResultsOne hundred patients entered the study, and 79 patients completed the study. Fifty-seven (72%) participants responded to treatment, with 34 (43%) participants having a ‘complete’ response (ie, final BFI<30) and 23 (29%) participants having a ‘partial’ response (ie, change in BFI≥12). In participants with a complete response, 73.5% were prescribed conventional laxatives, 12% were prescribed a peripherally acting mu-opioid receptor antagonist (PAMORA) and 14.5% were prescribed a PAMORA and conventional laxative.DiscussionThe feasibility study suggests that a definitive study can be successfully completed. However, we will amend the methodology to try to improve participant recruitment, participant retention and adherence to the treatment algorithm. The feasibility study also suggests that the use of the BFI to monitor OIC, and the use of a treatment algorithm to manage OIC, can result in clinically important improvements in OIC.Trial registration numberNCT04404933

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Laxatives for the management of constipation in people receiving palliative care

Candy

Jones

Larkin³

et al. 2015

Cochrane Database of Systematic Reviews

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BackgroundThis article describes the second update of a Cochrane review on the effectiveness of laxatives for the management of constipation in people receiving palliative care. Previous versions were published in 2006 and 2010 where we also evaluated trials of methylnaltrexone; these trials have been removed as they are included in another review in press. In these earlier versions, we drew no conclusions on individual effectiveness of different laxatives because of the limited number of evaluations. This is despite constipation being common in palliative care, generating considerable suffering due to the unpleasant physical symptoms and the availability of a wide range of laxatives with known differences in effect in other populations. ObjectivesTo determine the effectiveness and differential efficacy of laxatives used to manage constipation in people receiving palliative care. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library), MEDLINE, EMBASE, CINAHL and Web of Science (SCI & CPCI-S) for trials to September 2014. Selection criteriaRandomised controlled trials (RCTs) evaluating laxatives for constipation in people receiving palliative care. Data collection and analysisTwo authors assessed trial quality and extracted data. The appropriateness of combining data from the studies depended upon clinical and outcome measure homogeneity. Main resultsWe identified five studies involving the laxatives lactulose, senna, co-danthramer, misrakasneham, docusate and magnesium hydroxide with liquid paraffin. Overall, the study findings were at an unclear risk of bias. As all five studies compared different laxatives or combinations of laxatives, it was not possible to perform a meta-analysis. There was no evidence on whether individual laxatives were more effective than others or caused fewer adverse effects. Laxatives for the management of constipation in people receiving palliative care (Review)

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Clinical use of oral laxatives in palliative care services in Spain

Abstract: The clinical practice of the use of oral laxatives in palliative care in our environment differs widely from that recommended in the literature. Further studies are required to confirm if a revision of clinical guidelines are required.

Cited by 9 publications

References 15 publications

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

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

Opioid-induced constipation: a stepwise treatment algorithm feasibility study

Laxatives for the management of constipation in people receiving palliative care

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