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Constipation in Cancer Patients — an Update of Clinical Evidence

  • Palliative and Supportive Care (J Hardy, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion Statement

Constipation is one of the most frequent problems in cancer patients, and its etiology is multifactorial. It leads to decreased quality of life and impedes optimal pain treatment. Despite the high prevalence, constipation is frequently underdiagnosed mainly because of lack of validated diagnostic criteria or widely accepted definition of constipation in cancer patients. All cancer patients should be evaluated regularly for constipation, and concomitant causes and risk factors were assessed. Opioids are responsible for a much of the secondary constipation in cancer patients. The management of constipation in cancer patients should be multifaceted, addressing dietary and behavioral issues and optimizing pharmacological interventions. Prevention of opioid-induced constipation (OIC) is pivotal, as treatment is often unsatisfactory or inefficient. Dietary and behavioral interventions should be considered. Non-pharmacological measures include hydration and nutrition, ensuring privacy during defecation, using a commode or footstool, and the availability of a caregiver. Abdominal massage may be of value. Traditional laxatives are recommended in prevention but not in the treatment of OIC. Peripherally acting mu-opioid receptor antagonists (PAMORA) appear the first choice in the treatment and an alternative to laxatives in some recent clinical practice guidelines in preventing OIC. Naldemedine, naloxegol, and methylnaltrexone are supported by quality evidence for OIC management. Naloxone or naltrexone, taken orally in combined formulations with opioids, may be valuable in preventing or reducing OIC symptoms.

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  1. Laboratory of Palliative Medicine, Department of Social Medicine and Public Health, Medical University of Warsaw, ul. Oczki 3, 02-007, Warsaw, Poland

    Tomasz Dzierżanowski MD, PhD

  2. Regional Center for Pain Relief and Palliative/Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy

    Sebastiano Mercadante MD, PhD

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Tomasz Dzierzanowski has received compensation for service as a consultant from Bausch Health, and has received speaker’s honoraria as well as non-financial support (equipment, materials, etc.) from Molteni Farmaceutici. Sebastiano Mercadante declares that he has no conflict of interest.

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Dzierżanowski, T., Mercadante, S. Constipation in Cancer Patients — an Update of Clinical Evidence. Curr. Treat. Options in Oncol. 23, 936–950 (2022). https://doi.org/10.1007/s11864-022-00976-y

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