Abstract
Background
During opioid treatment of cancer pain, constipation is one of the most prevalent and bothersome side effects. Guidelines suggest that treatment with laxatives should be initiated when opioid therapy is started.
Aim
This study aims: (1) to determine to what extent patients, starting on opioids due to cancer pain, receive laxatives; (2) to examine the temporal relationship between initiation of opioid therapy and initiation of treatment with laxatives; and (3) to study to which extent the treatment follows current guidelines.
Methods
Data from the Norwegian prescription database (NorPD) were used to investigate dispensed prescriptions of laxatives to outpatients in Norway, who are receiving opioids for cancer pain. Data from NorPD cover all dispensed prescriptions of drugs to outpatients, making it possible to follow patients over time. The study cohort was followed from 2005 to the end of 2008.
Results
Of 2,982 patients who started opioid therapy directly with WHO step III opioids, 1,325 patients (44.4 %) did not receive laxatives during the study period. Only 738 patients (24.7 %) received laxatives at the same time as opioid therapy was initiated. Another 657 patients (22.0 %) received laxatives after their initiation of opioids at some time during the study period.
Conclusion
Of those who started directly on a strong opioid, only one fourth received laxatives concomitantly with the first opioid, and nearly half did not receive laxatives at all. These findings indicate that the current guidelines are not followed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Norwegian Medicines Agency (2001) Palliative treatment in hospitals and at home. http://www.legemiddelverket.no/upload/16261/publikasjon2-2001.pdf
Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R (2009) The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med 10:35–42
Droney J, Ross J, Gretton S, Welsh K, Sato H, Riley J (2008) Constipation in cancer patients on morphine. Support Care Cancer 16:453–459
Fredheim OM, Skurtveit S, Breivik H, Borchgrevink PC (2009) Increasing use of opioids from 2004 to 2007—pharmacoepidemiological data from a complete national prescription database in Norway. Eur J Pain 14:289–294
Hanks GW, Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Casas JR, Sawe J, Twycross RG, Ventafridda V (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593
Holzer P (2007) Treatment of opioid-induced gut dysfunction. Expert Opin Investig Drugs 16:181–194
Kurz A, Sessler DI (2003) Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs 63:649–671
Laugsand EA, Kaasa S, de Conno F, Hanks G, Klepstad P (2009) Intensity and treatment of symptoms in 3,030 palliative care patients: a cross-sectional survey of the EAPC Research Network. J Opioid Manag 5:11–21
Fallon M, Cherny NI, Hanks G (2010) Opioid analgesic therapy. In: Hanks GWC (ed) Oxford textbook of palliative medicine. Oxford University, Oxford, p 689
Miles CL, Fellowes D, Goodman ML, Wilkinson S (2006) Laxatives for the management of constipation in palliative care patients. Cochrane Database Syst Rev (4):CD003448
Noguera A, Centeno C, Librada S, Nabal M (2010) Clinical use of oral laxatives in palliative care services in Spain. Support Care Cancer 18:1491–1494
Pappagallo M (2001) Incidence, prevalence, and management of opioid bowel dysfunction. Am J Surg 182:11S–18S
Schug SA, Zech D, Grond S, Jung H, Meuser T, Stobbe B (1992) A long-term survey of morphine in cancer pain patients. J Pain Symptom Manag 7:259–266
Skurtveit S, Furu K, Kaasa S, Borchgrevink PC (2009) Introduction of low dose transdermal buprenorphine—did it influence use of potentially addictive drugs in chronic non-malignant pain patients? Eur J Pain 13:949–953
Svendsen K, Borchgrevink P, Fredheim O, Hamunen K, Mellbye A, Dale O (2010) Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses 25(7):725–732
Sykes NP (1998) The relationship between opioid use and laxative use in terminally ill cancer patients. Palliat Med 12:375–382
Wirz S, Klaschik E (2005) Management of constipation in palliative care patients undergoing opioid therapy: is polyethylene glycol an option? Am J Hosp Palliat Care 22:375–381
World Health Organization (1996) Cancer pain relief: with a guide to opioid availability, 2nd ed. Geneva
Conflict of interest
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. We do have full control of all the primary data and agree to allow the journal to review the data if requested.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(PDF 14 kb)
Rights and permissions
About this article
Cite this article
Skollerud, L.M., Fredheim, O.M., Svendsen, K. et al. Laxative prescriptions to cancer outpatients receiving opioids: a study from the Norwegian prescription database. Support Care Cancer 21, 67–73 (2013). https://doi.org/10.1007/s00520-012-1494-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-012-1494-8