Abstract
•List evidence-based recommendations for management of opioid-induced constipation in patients with cancer.•Compare interventions for management of constipation in patients with cancer•Recognize components of rigorous systematic review methodology. Constipation occurs in over 60% of persons with cancer during treatment and in palliative care. Constipation leads to physical and psychological distress and impacts quality of life; however, the evidence on prevention and resolution of symptoms is limited. A systematic review and meta-analysis was conducted to inform the development of national clinical practice guidelines on the symptom management of constipation among persons with cancer. This review presents the comparative efficacy of lifestyle, pharmacologic, and complementary therapy interventions for the prevention and treatment of chronic and opioid-induced constipation. We searched PubMed, Wiley Cochrane Library and CINAHL through May 2019. Two investigators independently reviewed titles, abstracts and full-text studies for inclusion, extracting data from eligible studies. Primary outcomes included spontaneous bowel movement, stool frequency, stool consistency, straining, quality of life, and adverse events leading to treatment discontinuation. We assessed risk of bias using the Cochrane risk of bias tool and assessed the certainty of the evidence using the GRADE approach. Eight studies informed low/very low certainty of evidence of moderate benefit for osmotic or stimulant laxatives, methylnaltrexone, naldemedine and small benefit for naloxegol, prucalopride, alvimopan, lubiprostone, and linaclotide in addition to lifestyle factors for OIC. For chronic constipation, 14 studies informed low certainty of evidence of moderate benefit of osmotic or stimulant laxatives, very low certainty of trivial benefit of acupuncture, and very low certainty of moderate benefit of electroacupuncture. This review summarizes the evidence on lifestyle, pharmaceutical, and complementary medicine approaches to the management of chronic and opioid-induced constipation while identifying gaps in the evidence and synthesizing current evidence to guide clinical care.
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