ONS Guidelines™ for Opioid-Induced and Non–Opioid-Related Cancer Constipation

Rogers, Barbara; Ginex, Pamela; Anbari, Allison B.; Hanson, Brian; LeFebvre, Kristine B.; Lopez, Rachael; Thorpe, Deborah M.; Wolles, Brenda; Moriarty, Kerri A.; Maloney, Christine; Vrabel, Mark

doi:10.1188/20.onf.671-691

Cited by 9 publications

(2 citation statements)

References 76 publications

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“…Further concerns for patients receiving opioid therapy include adverse effects such as the development of tolerance, physical dependence, cognitive dysfunction, constipation, and nausea [ 49 ]. While there are guidelines relating to the management of opioid-induced adverse effects among patients with cancer [ 50 , 51 , 52 ], there is limited information on the incidence or prevalence of effects related to dependence and tolerance. The onset of adverse effects, as well as their potential for alleviation, are important considerations for patients, who need to weigh the tradeoffs between these symptoms, their impact on wellbeing and functioning, and the potential for experiencing freedom from pain.…”

Section: What Are the Risks Of Opioid Use Among Advanced Cancer Patie...mentioning

confidence: 99%

The Stigma Surrounding Opioid Use as a Barrier to Cancer-Pain Management: An Overview of Experiences with Fear, Shame, and Poorly Controlled Pain in the Context of Advanced Cancer

Harsanyi,

Cuthbert,

Schulte

2023

Current Oncology

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Cancer-related pain affects a majority of patients with advanced cancer and is often undertreated. The treatment of this pain is largely reliant on the use of opioids, which are essential medicines for symptom management and the maintenance of quality of life (QoL) for patients with advanced cancer. While there are cancer-specific guidelines for the treatment of pain, widespread publication and policy changes in response to the opioid epidemic have drastically impacted perceptions of opioid use. This overview therefore aims to investigate how manifestations of opioid stigma impact pain management in cancer settings, with an emphasis on the experiences of patients with advanced cancer. Opioid use has been widely stigmatized in multiple domains, including public, healthcare, and patient populations. Physician hesitancy in prescribing and pharmacist vigilance in dispensing were identified as barriers to optimal pain management, and may contribute to stigma in the context of advanced cancer. Evidence in the literature suggests that opioid stigma may result in patient deviations from prescription instructions, which generally leads to pain undertreatment. Patients reflected on experiencing shame and fear surrounding their prescription opioid use and feeling uncomfortable communicating with their healthcare providers on these topics. Our findings indicate that future work is required to educate patients and providers in order to de-stigmatize opioid use. Through alleviating stigma, patients may be better able to make decisions regarding their pain management which lead to freedom from cancer-related pain and improved QoL.

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Section: What Are the Risks Of Opioid Use Among Advanced Cancer Patie...mentioning

confidence: 99%

The Stigma Surrounding Opioid Use as a Barrier to Cancer-Pain Management: An Overview of Experiences with Fear, Shame, and Poorly Controlled Pain in the Context of Advanced Cancer

Harsanyi,

Cuthbert,

Schulte

2023

Current Oncology

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“…Recentemente molte società scientifiche hanno pubblicato linee guida sulla gestione della OIC, con lo scopo di sensibilizzare i clinici a questa problematica, nonché fornire indicazioni specifiche di trattamento basate sulle evidenze scientifiche ad oggi disponibili. [11][12][13][14][15][16][17] In generale, tutte le linee guida raccomandano un approccio di trattamento step-up, che inizialmente preveda generiche indicazioni sullo stile di vita (in particolare un adeguato introito di fibre e di liquidi associato ad una regolare attività fisica moderata, qualora possibile) e l'utilizzo preventivo di lassativi tradizionali, osmotici o stimolanti. Le linee guida invitano inoltre a rivalutare la reale necessità di farmaci che possono contribuire ad un peggioramento della stipsi (ad esempio, antiacidi contenete alluminio, antidepressivi triciclic, antistaminici, antispastici, antipsicotici, supplementazioni di ferro e calcio, calcioanatagonisti), considerando eventuali alternative terapeutiche, e suggeriscono di valutare l'opportunità di switching a farmaci con minori effetti sulla motilità gastroenterica, come la combinazione di oppioidi con azione agonista/antagonista a livello recettoriale (es.…”

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Stipsi indotta da oppioidi: un problema emergente con nuove opportunità terapeutiche

Radaelli

Paolo

2021

Ital J Med

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Risk and main contributing factors for constipation in patients with gastrointestinal cancer: a multicenter cross-sectional study in China

Lü

Yang

et al. 2022

Support Care Cancer

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Background and objectives: The purpose of this study is to determine the risk of constipation and to identify the signi cant risk factors for constipation in patients with gastrointestinal cancer using the Chinese version of the Constipation Risk Assessment Scale (CRAS-C), as well as to explore the complementary constipation risk factors in patients with gastrointestinal cancer, to improve the speci city of the CRAS-C in this population, and nally to provide a theoretical basis for constipation prevention.Research design and methods: A cross-sectional study involving multiple centers was conducted. A total of 190 patients with gastrointestinal cancer completed surveys that included demographic information, defecation habits, and the CRAS-C. The mean, SD, median, maximum, minimum, frequency, and percentage were used as indicators for the constipation risk and signi cant risk factors. The t-test and Chi-square tests were used to analyze constipation indicators in patients with gastrointestinal cancer.Results: 190 patients were 58.92±12.07 years of age.The total CRAS-C mean (SD) score was 13.22 (4.69).51 patients (26.8%) scored lower than 11, who were at the low risk level of constipation. 139 patients (73.2%) scored 11 or above, who were at the high risk level of constipation. The top 10 factors were insu cient liquid intake(81.1%), failure to consume bran products daily(78.9%), insu cient ber intake(77.9%), antiemetics (74.7%), cytotoxic chemotherapy (52.6%), colorectal/abdominal diseases (42.6%), opioid analgesics (35.3%), opioid analgesics(26.8%), calcium channel blockers (16.3%), endocrine disorders (14.2%). Chi square test showed that constipating for most of the past 3 months, ascites and ECOG score were complementary constipation risk factors in gastrointestinal cancer patients. Conclusion:The ndings indicate that most gastrointestinal cancer patients were at a high risk of constipation. There are also several complementary constipation risk factors and CRAS-C can be further revised in future studies to make it more speci c in gastrointestinal cancer patients. Integrating CRAS into the pathway of constipation management, carrying out constipation risk screening for hospitalized cancer patients, building systematic constipation prevention plan based on risk assessment are important to reduce the incidence of constipation in patients with gastrointestinal cancer, and improve the quality of life.What Is Already Known About The Topic?The incidence of constipation in patients with gastrointestinal cancer is the highest and most serious among all cancer patients.The Chinese version Constipation Risk Assessment Scale (CRAS-C) demonstrated favourable content validity, predictive validity and interrater reliability in cancer patients in the previous study and could be used in the identi cation of cancer patients at risk of constipation. But it hasn't been used in gastrointestinal cancer patients. What This Paper AddsThe risk of constipation in patients with gastrointestinal cancer is generally high, which needs to be...

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ONS Guidelines™ for Opioid-Induced and Non–Opioid-Related Cancer Constipation

Cited by 9 publications

References 76 publications

The Stigma Surrounding Opioid Use as a Barrier to Cancer-Pain Management: An Overview of Experiences with Fear, Shame, and Poorly Controlled Pain in the Context of Advanced Cancer

The Stigma Surrounding Opioid Use as a Barrier to Cancer-Pain Management: An Overview of Experiences with Fear, Shame, and Poorly Controlled Pain in the Context of Advanced Cancer

Stipsi indotta da oppioidi: un problema emergente con nuove opportunità terapeutiche

Risk and main contributing factors for constipation in patients with gastrointestinal cancer: a multicenter cross-sectional study in China

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