Abstract
BackgroundOpioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical approach of OIC in cancer patient.MethodsA modified Delphi method was conducted involving 46 different physicians experts in OIC. Using a structured questionnaire of 67 items this project intended to seek consensus on aspects related to diagnosis, treatment, and quality of life of cancer patients suffering with OIC.ResultsAfter two rounds, a consensus was reached in 91% of the items proposed, all in agreement. Agreement was obtained on OIC definition (95.7%). Objective and patient-reported outcomes included in that definition should be assessed routinely in clinical practice. Responsive to symptom changes and easy-to-use assessment tools were recommended (87.2%). Successful diagnosis of OIC requires increase clinicians awareness of OIC and proactivity to discuss symptoms with their patients (100%). Successful management of OIC requires individualization of the treatment (100%), regular revaluation once is established, and keeping it for the duration of opioid treatment (91.5%). Oral Peripherally Acting μ-Opioid Receptor Agonists (PAMORAs), were considered good alternatives for the treatment of OIC in cancer patients (97.9%). This drugs and laxatives can be co-prescribed if OIC coexist with functional constipation.ConclusionsThe panelists, based on their expert clinical practice, presented a set of recommendations for the management of OIC in cancer patients.
Highlights
Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients
OIC occurs in 51–87% of patients receiving opioids for cancer [11]
OIC is one of the most common causes of constipation in cancer patients, there are many other factors that can contribute to the development of constipation or exacerbate OIC symptoms [12,13,14]
Summary
Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Pain prevalence in patients with cancer ranges from 39.3% after curative treatment, 55.0% during anticancer treatment, and 66.4–80% in advanced disease [1]. Because of this high prevalence, it is a priority to establish adequate control of pain in these patients [2]. OIC occurs in 51–87% of patients receiving opioids for cancer [11]. Functional constipation and OIC have similar presentation, but their physiopathology is different. They have been well-defined in Rome IV criteria publication [12]
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