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Symptom screening for constipation in oncology: getting to the bottom of the matter

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Abstract

Purpose

This study seeks to determine whether specific screening for constipation will increase the frequency of clinician response within the context of an established symptom screening program.

Methods

A “constipation” item was added to routine Edmonton Symptom Assessment System (ESAS) screening in gynecologic oncology clinics during a 7-week trial period, without additional constipation-specific training. Chart audits were then conducted to determine documentation of assessment and intervention for constipation in three groups of patients, those who completed (1) ESAS (n = 477), (2) ESAS-C with constipation (n = 435), and (3) no ESAS (n = 511).

Results

Among patients who were screened for constipation, 17% reported moderate to severe symptoms. Greater constipation severity increased the likelihood of documented assessment (Z = 2.37, p = .018) and intervention (Z = 1.99, p = .048). Overall rates of documented assessment were 36%, with the highest assessment rate in the no ESAS group (χ2 = 9.505, p = .006), a group with the highest proportion of late-stage disease. No difference in the rate of assessment was found between the ESAS and ESAS-C groups. Overall rates for documentation of intervention were low, and did not differ between groups.

Conclusions

Specific screening for constipation within an established screening program did not increase the documentation rate for constipation assessment or intervention. The inclusion of specific symptoms in multi-symptom screening initiatives should be carefully evaluated in terms of added value versus patient burden. Care pathways should include guidance on triaging results from multi-symptom screening, and clinicians should pay particular attention to patients who are missed from screening altogether, as they may be the most symptomatic group.

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Author information

Authors and Affiliations

  1. Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 16th Floor, Room 749, 610 University Avenue, Toronto, ON, M5G 2M9, Canada

    Madeline Li, Caroline Sanders, Chieh-Hsin Lee, Bryan Gascon, Alyssa Macedo & Yvonne W. Leung

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Madeline Li & Yvonne W. Leung

  3. Quality, Patient Safety & Enterprise Risk, St. Joseph’s Health Centre, Toronto, ON, Canada

    Sean Molloy

  4. Department of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Stephane Laframboise

  5. de Souza Institute, University Health Network, Toronto, ON, Canada

    Yvonne W. Leung

Authors
  1. Madeline Li
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  2. Caroline Sanders
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  3. Chieh-Hsin Lee
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  4. Bryan Gascon
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  5. Alyssa Macedo
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  6. Sean Molloy
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  7. Stephane Laframboise
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  8. Yvonne W. Leung
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Corresponding author

Correspondence to Madeline Li.

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Conflict of interest

Dr. Madeline Li reports sponsorship from Cancer Care Ontario, during the conduct of the study. None of the other authors have any financial disclosures or conflicts of interests to declare.

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Li, M., Sanders, C., Lee, CH. et al. Symptom screening for constipation in oncology: getting to the bottom of the matter. Support Care Cancer 27, 2463–2470 (2019). https://doi.org/10.1007/s00520-018-4520-7

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  • DOI: https://doi.org/10.1007/s00520-018-4520-7

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