Constipation in advanced cancer patients

Abstract

Constipation is a frequent, distressing, and underestimated complication in patients with advanced cancer. It may develop from general disturbances that may or may not be cancer related, but the use of opioids is one of the main causes in this population. Opioids affect the intestine by reducing motility and secretions and by increasing fluid absorption and blood flow. Untreated constipation may lead to several complications. Effective management of constipation starts with a careful assessment of the patient, including the history of the frequency and difficulty of defaecation, symptoms caused by constipation, and physical and rectal examinations. When the diagnosis of constipation is unclear, an abdominal X-ray may be required. The treatment of constipation includes general interventions, such as the availability of comfort and privacy or the elimination of medical factors that may contribute to constipation, and therapeutic interventions including oral or rectal laxatives and the use of prokinetic drugs and naloxone. The purpose of this paper is to review the pathophysiology and causes of constipation and the effects of opioids on the gastrointestinal tract, and to propose an approach for its assessment and management. Randomized clinical trials between different laxatives and/or prokinetic agents in cancer patients are needed, and future studies should focus on the validation of different clinical assessment tools for constipation.

Symptom Clusters in Advanced Cancer Patients: An Empirical Comparison of Statistical Methods and the Impact on Quality of Life

“…Constipation in advanced cancer patients shares some of these causes, but also has local causes, e.g., gut motility or pelvic floor dysfunction (29,30). Diarrhoea, in contrast, is commonly associated with some treatments and is largely an acute symptom in advanced cancer patients (31).…”

Abatement of Morphine-Induced Slowing in Gastrointestinal Transit by Dai-kenchu-to, a Traditional Japanese Herbal Medicine

“…However, it induces severe constipation, causing an obvious reduction in quality of life (QOL) (1). In a previous examination of records of cancer patients at a hospital (Chiba Rosai Hospital, Chiba), we found that 64.9% of patients who take morphine-containing drugs suffer from severe constipation (2).…”

Predominance of δ-Opioid-Binding Sites in the Porcine Enteric Nervous System

“…The gastroenterologic use of opioids has recently been extended to the alleviation of diarrhea and visceral pain in irritable bowel syndrome (Corazziari, 1999). In addition to their therapeutic effects, opioids produce severe constipation during their prolonged use in pain management (Mancini and Bruera, 1998). The actions of opioids are thought to stem from their ability to decrease both intestinal propulsion and mucosal anion secretion (De Luca and Coupar, 1996).…”