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More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer

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Abstract

Purpose

Opioid-induced constipation (OIC) is a distressing physical symptom for patients with cancer taking opioids. Total opioid consumption may contribute to developing worsening OIC-related symptoms. We completed a retrospective analysis examining the association of total daily opioid consumption on self-reported constipation in patients with cancer.

Methods

In over 5 clinic visits, we collected self-reported constipation scores and 24-h oral morphine equivalents (OME). We examined the association between OME and the presence of constipation (i.e., score > 3) and the relationship of OME between patients with or without constipation.

Results

Of 297 patients with cancer, we observed 57.8% with constipation and 42.4% without constipation at the first clinic visit. Age was similar in both groups (54.2 ± 14.5 vs. 56.4 ± 14.8 years [mean ± SD]) and the majority of patients were women (63.7% vs. 61.1%). The most common cancer type in patients with constipation was non-colorectal gastrointestinal (n = 25, 14.6%), while in patients without constipation was colorectal gastrointestinal (n = 25; 19.8%). Across visits, we observed weak or no association between OME and self-reported constipation (r = 0.01–0.27). At the first visit, higher mean OME was seen in patients who self-reported constipation (133.4 vs 76; p < 0.05). Age, sex, metastatic disease, and stimulant laxative use were not associated with constipation.

Conclusions

We observed weak to no association between OME and constipation in patients with cancer. These results suggest a lack of a clear association between total opioid consumption and self-reported constipation.

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References

  1. Forootan M, Bagheri N, Darvishi M (2018) Chronic constipation: a review of literature. Medicine (Baltimore) 97(20):e10631. https://doi.org/10.1097/MD.0000000000010631

    Article  Google Scholar 

  2. Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R (2018) Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol 3(3):203–212. https://doi.org/10.1016/S2468-1253(18)30008-6

    Article  PubMed  Google Scholar 

  3. 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(1):35–42. https://doi.org/10.1111/j.1526-4637.2008.00495.x

    Article  PubMed  Google Scholar 

  4. Hatswell AJ, Vegter S (2016) Measuring quality of life in opioid-induced constipation: mapping EQ-5D-3 L and PAC-QOL. Health Econ Rev 6(1):14. https://doi.org/10.1186/s13561-016-0091-9

    Article  PubMed  PubMed Central  Google Scholar 

  5. Veiga, D. R., Mendonca, L., Sampaio, R., Lopes, J. C., & Azevedo, L. F. (2018). Incidence and health related quality of life of opioid-induced constipation in chronic noncancer pain patients: a prospective multicentre cohort study. Pain Res Treat, 2018, 5704627. doi:https://doi.org/10.1155/2018/5704627, 1, 11

    Article  Google Scholar 

  6. Thorpe DM (2001) Management of opioid-induced constipation. Curr Pain Headache Rep 5(3):237–240

    Article  CAS  Google Scholar 

  7. Kalso E, Edwards JE, Moore RA, McQuay HJ (2004) Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112(3):372–380. https://doi.org/10.1016/j.pain.2004.09.019

    Article  CAS  PubMed  Google Scholar 

  8. Abramowitz L, Beziaud N, Labreze L, Giardina V, Causse C, Chuberre B et al (2013) Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: DYONISOS study. J Med Econ 16(12):1423–1433. https://doi.org/10.3111/13696998.2013.851082

    Article  CAS  PubMed  Google Scholar 

  9. Webster LR (2015) Opioid-induced constipation. Pain Med 16(Suppl 1):S16–S21. https://doi.org/10.1111/pme.12911

    Article  PubMed  Google Scholar 

  10. Neefjes EC, van der Vorst MJ, Boddaert MS, Zuurmond WW, van der Vliet HJ, Beeker A, van den Berg HP, van Groeningen CJ, Vrijaldenhoven S, Verheul HMW (2014) Clinical evaluation of the efficacy of methylnaltrexone in resolving constipation induced by different opioid subtypes combined with laboratory analysis of immunomodulatory and antiangiogenic effects of methylnaltrexone. BMC Palliat Care 13:42. https://doi.org/10.1186/1472-684X-13-42

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7(2):6–9

    Article  CAS  Google Scholar 

  12. Walker PW, Palla S, Pei BL, Kaur G, Zhang K, Hanohano J, Munsell M, Bruera E (2008) Switching from methadone to a different opioid: what is the equianalgesic dose ratio? J Palliat Med 11(8):1103–1108. https://doi.org/10.1089/jpm.2007.0285

    Article  PubMed  PubMed Central  Google Scholar 

  13. Arnold R, Weissman DE (2003) Calculating opioid dose conversions #36. J Palliat Med 6(4):619–620. https://doi.org/10.1089/109662103768253731

    Article  PubMed  Google Scholar 

  14. Rhondali W, Nguyen L, Palmer L, Kang DH, Hui D, Bruera E (2013) Self-reported constipation in patients with advanced cancer: a preliminary report. J Pain Symptom Manag 45(1):23–32. https://doi.org/10.1016/j.jpainsymman.2012.01.009

    Article  Google Scholar 

  15. Noguera A, Centeno C, Librada S, Nabal M (2009) Screening for constipation in palliative care patients. J Palliat Med 12(10):915–920. https://doi.org/10.1089/jpm.2009.0054

    Article  PubMed  Google Scholar 

  16. Nelson AD, Camilleri M (2016) Opioid-induced constipation: advances and clinical guidance. Ther Adv Chronic Dis 7(2):121–134. https://doi.org/10.1177/2040622315627801

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Goodin S, Cunningham R (2002) 5-HT(3)-receptor antagonists for the treatment of nausea and vomiting: a reappraisal of their side-effect profile. Oncologist 7(5):424–436

    Article  CAS  Google Scholar 

  18. Perez EA, Hesketh P, Sandbach J, Reeves J, Chawla S, Markman M, Hainsworth J, Bushnell W, Friedman C (1998) Comparison of single-dose oral granisetron versus intravenous ondansetron in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy: a multicenter, double-blind, randomized parallel study. J Clin Oncol 16(2):754–760. https://doi.org/10.1200/JCO.1998.16.2.754

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Dr. Roeland’s research is supported by an Alliance Cancer Control Program Junior Faculty Award (#UG1CA189823), UC San Diego Clinical Translational Research Institute KL2 Career Development Award (#KL2TR001444), and Cambia Health Foundation Sojourns Scholars Leadership Program.

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Authors and Affiliations

  1. Massachusetts General Hospital Cancer Center, Boston, MA, USA

    Eric J. Roeland

  2. Moores Cancer Center, University of California (UC) San Diego, La Jolla, CA, USA

    Christopher J. Sera

  3. Skaggs School of Pharmacy and Pharmaceutical Sciences, UC San Diego, 9500 Gilman Drive, MC 0714, La Jolla, CA, 92093-0714, USA

    Joseph D. Ma

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  1. Eric J. Roeland
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  2. Christopher J. Sera
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  3. Joseph D. Ma
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Correspondence to Joseph D. Ma.

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IRB approval was granted by the University of California (UC), San Diego Human Research Projections Program.

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Roeland, E.J., Sera, C.J. & Ma, J.D. More opioids, more constipation? Evaluation of longitudinal total oral opioid consumption and self-reported constipation in patients with cancer. Support Care Cancer 28, 1793–1797 (2020). https://doi.org/10.1007/s00520-019-04996-7

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  • DOI: https://doi.org/10.1007/s00520-019-04996-7

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