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Trajectory of Medication-Induced Constipation in Patients With Cancer

Susan C. McMillan

Cindy S. Tofthagen

Brent J. Small

Sloan Karver

David Craig

constipation, opioid, vinca alkaloids
ONF 2013, 40(3), E92-E100. DOI: 10.1188/13.ONF.E92-E100

Purpose/Objectives: To determine the severity and trajectory of constipation among patients with cancer from opioids and/or vinca alkaloids.

Design: Exploratory, descriptive.

Setting: Moffitt Cancer Center, a National Cancer Institute-designated comprehensive cancer center in Tampa, FL.

Sample: 400 patients at risk for developing medication-induced constipation from opioids, vinca alkaloids, or both.

Methods: Patients' baseline data included the Constipation Assessment Scale (CAS), the constipation item from the Memorial Symptom Assessment Scale (MSAS) for intensity and distress, and the laxative interview. Following the interview, the medical chart was reviewed for clinical and demographic data. Patients were asked about constipation (CAS) and laxatives consumed (laxative interview) during eight weekly telephone calls.

Main Research Variables: Constipation presence, intensity, and distress.

Findings: At baseline, 63% of patients reported some level of constipation. During the eight weeks, constipation fluctuated with scores ranging from 0-16, with the opioid-only group showing a small but statistically significant decrease in intensity. Constipation intensity and distress on the MSAS were significantly correlated (r = 0.76; p = 0.000).

Conclusions: The majority of the sample reported constipation that ranged from mild to severe, persisted over time, and caused symptom distress. Therefore, healthcare providers in the cancer center likely were neither adequately managing the medication-induced constipation nor apparently teaching patients to manage it themselves.

Implications for Nursing: National Comprehensive Cancer Network guidelines support the importance of managing medication-induced constipation. However, guidelines are not being followed in many cases; therefore, more focus is needed on constipation in clinical and educational settings as well as more research.

Knowledge Translation: Patients receiving opioids and vinca alkaloids are at risk of constipation. Currently, medication-induced constipation is poorly managed. Managing constipation may lessen symptom distress, thereby improving quality of life in these patients.

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