Abstract
Simple SummaryThe frequent use of opioid in-home palliative care settings is associated with a high incidence of opioid-induced constipation (OIC) that can significantly worsen a cancer patient’s quality of life. Laxative therapy is the first-line in OIC treatment, and although its application is recommended from the beginning of opioid therapy, in most cases it does not resolve the symptoms. Naloxegol is the specific target therapy for opioid-induced constipation. To our knowledge this is the first study aimed at evaluating the impact of a naloxegol therapy on the quality of life of advanced cancer patients with a short or very short life expectancy in a home palliative setting.This observational study aims to evaluate the efficacy of naloxegol therapy in resolving opioid-induced constipation (OIC) and in improving the quality of life in a home palliative care cancer setting. Advanced cancer patients with OIC (Rome IV criteria) not relieved by laxatives started a naloxegol therapy 25 mg/day for 4 weeks. Quality of life was evaluated by Patient Assessment of Constipation Quality-of-Life (PAC-QoL) at day 0 and day 28; background pain by Numerical Rating Scale, number of weekly spontaneous bowel movements and Bowel Function Index (BFI) were evaluated at day 0 and every week. Seventy-eight patients who completed the 4-week study improved all four PAC-QoL dimensions (physical and psychological discomfort, worries/concerns and satisfaction level). Weekly spontaneous bowel movements increased and BFI improved. Background pain reduced after seven days and remained lower during the following weeks. Seventy-two patients dropped out the study before day 28 with a reduced survival compared to patients completing the study. Even in these patients, an improvement of bowel function was observed after two weeks. Naloxegol was effective in improving the quality of life, resolving OIC and reducing overall pain in patients with advanced cancer.
Highlights
Opioids represent the most frequently used and effective pain therapy in cancer care settings [1]
The objective of this study was to evaluate if naloxegol therapy can improve the quality of life by reducing opioidinduced constipation (OIC) in a home palliative-care setting for advanced cancer patients
The majority of the patients were assisted by the ANT home palliative care program in Northern or Southern Italy (49.3% and 44.0%, respectively)
Summary
Opioids represent the most frequently used and effective pain therapy in cancer care settings [1]. The specific activation of μ-opioids receptors modifies gastrointestinal functions by reducing peristalsis, increasing sphincter tone, increasing fluid reabsorption and decreasing its secretion, with the consequent onset of constipation [2,3,4,5], called opioidinduced constipation (OIC). OIC is present in up to 90% of cancer patients, and occurs from the beginning of analgesic treatment [6,7]. The pain from constipation is added to that from the cancer itself, inducing anxiety and urgency in the patient to resolve the constipation. The doctor or the patients themselves may be led to reduce the opioid therapy, without resolving constipation but only producing a worsening of cancer pain [13]
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