A qualitative study to explore psychological distress and illness burden associated with opioid-induced constipation in cancer patients with advanced disease

1. Lara Dhingra
   1. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, USA; Department of Neurology, Albert Einstein College of Medicine, USA; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, USA
2. Elyse Shuk
   1. Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, USA
3. Bella Grossman
   1. The New School for Social Research, USA
4. Alessandra Strada
   1. East-West Psychology Department, California Institute of Integral Studies, USA
5. Emily Wald
   1. Teachers College, Columbia University, USA
6. Allison Portenoy
   1. Cornell University, USA
7. Helena Knotkova
   1. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, USA; Department of Neurology, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, USA; Department of Neurology, Albert Einstein College of Medicine, USA
8. Russell Portenoy
   1. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, USA; Departments of Neurology and Anesthesiology, Albert Einstein College of Medicine, USA

1. Lara K. Dhingra, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, 120 East 16^th Street, 12^th Floor, New York, NY 10003, USA. Email: Ldhingra@chpnet.org

Abstract

Background: Constipation affects many patients receiving long-term opioid therapy for cancer pain. Little is known about the nature of psychological distress and the burden associated with this problem. This information may inform the development of effective treatment strategies and ameliorate distress.

Aim: The objective was to use qualitative research methods to better understand psychological distress and the burden associated with opioid-induced constipation and its treatment in advanced cancer patients.

Design: In this qualitative study, semi-structured interviews explored perceptions of psychological distress and burden from opioid-induced constipation. Interviews were analyzed using a thematic content analysis approach involving descriptive and interpretive coding and identification of recurring themes.

Setting/participants: Twelve advanced cancer patients with opioid-induced constipation were recruited from a large urban hospital.

Results: Patients experienced various types of negative affect and cognitions associated with opioid-induced constipation. Analyses indicated three major themes: (1) irrational thoughts and educational needs; (2) psychological distress from constipation and (3) the effects of constipation on the decision to use opioid analgesics. Irrational thoughts and educational needs included beliefs that nutrition could improve constipation, the supposition that constipation indicated deteriorating health, and catastrophic beliefs. Psychological distress included depressive symptoms and anticipatory anxiety related to constipation. Decision-making revealed cognitive dissonance about using opioids and conflicting preferences about continuing use. 

Conclusions: 

Future investigation of the multiple components of cognitive and affective burden from opioid-induced constipation is warranted. Understanding the varied nature of this burden may improve clinical recognition and assessment and promote more intensive management consistent with the distress it produces.

• Burden of illness
• cancer
• educational needs
• opioid analgesics
• opioid-induced constipation
• psychological stress
• qualitative research