A cross-sectional study of constipation and laxative use in advanced cancer patients: insights for revision of current practice.

Cheng CW, Kwok AO, Bian ZX, Tse DM.

Source

Yan Chai Hospital-Hong Kong Baptist University Clinical Centre for Training and Research in Chinese Medicine (West Kowloon), Hong Kong, SAR, China.

Abstract

PURPOSE:

This study aimed to evaluate the bowel habit and laxative use in advanced cancer patients with constipation in palliative care unit.

METHODS:

It was a cross-sectional study using a self-designed questionnaire.

RESULTS:

A total of 225 patients were analysed. Among all patients, 92.0 % (207 patients) had any intervention for relief of constipation, including laxatives, suppositories, enemas, digital evacuation and Chinese herbal medicine, and 65.3 % (147 patients) were on laxatives prescribed by our doctors. The severity of constipation as assessed by the constipation visual analogue scale (CVAS) (0-7, 7 = most severe) was reported as no constipation (0-1) in 19.6 % of patients, constipation (2-4) in 50.7 % and severe constipation (5-7) in 29.8 %. More patients with severe constipation, as compared with patients with constipation and no constipation, reported inadequate pushing force (83.6 vs. 47.4 vs. 6.8 %), sense of incomplete defecation (40.3 vs. 14.9 vs. 6.8 %) and difficult defecation (58.2 vs. 26.3 vs. 0 %), all p < 0.001, but there was no difference in stool types as assessed by Bristol Stool Scale (p = 0.303). Patients not on opioids, as compared with patients on strong opioids, had similar CVAS scores and description of constipation but had least laxatives prescribed (60.2 vs. 78.9 %, p = 0.012).

CONCLUSION:

Evaluation of constipation should not rely on stool form or consistency alone, and patient's description of constipation is worth consideration. Constipation is also a problem in patients not on opioids and more attention is required.
 A revisit to existing guidelines is needed.

Comment in

Response to "A cross-sectional study of constipation and laxative use in advanced cancer patients: insights for revision of current practise". [Support Care Cancer. 2012]

Support Care Cancer. 2013 Jan;21(1):149-56. doi: 10.1007/s00520-012-1504-x. Epub 2012 Jun 1.