Inadequate management of opioid-induced constipation in European cancer pain patients: results of a real-world, multicentre, observational study ("E-StOIC")

Support Care Cancer. 2024 Oct 5;32(10):701. doi: 10.1007/s00520-024-08898-1.

Abstract

Purpose: The objectives of the study were to determine the prevalence of (uncontrolled) OIC, relevant medications / interventions employed by healthcare professionals, and the additional strategies utilised by patients, amongst European patients with cancer pain.

Methods: This study was a prospective observational study conducted at 24 research sites in ten European countries. Cancer patients receiving opioid analgesics for at least a week were recruited, and asked to complete a questionnaire including background information, single question (Are you constipated?), Rome IV diagnostic criteria for OIC, Bowel Function Index (BFI), and Patient Assessment of Constipation Quality of Life questionnaire (PAC-QOL). Participants were characterised as having / not having OIC on the basis of the Rome IV diagnostic criteria.

Results: 1200 participants completed the study. 59.5% met the Rome IV diagnostic criteria for OIC: only 61.5% that met these criteria self-reported constipation. 72% participants were prescribed a regular conventional laxative / peripherally acting mu-opioid receptor antagonist (PAMORA). However, only 66% took their prescribed laxatives every day. Many participants had utilised other strategies / interventions to manage their OIC. Furthermore, 27% had needed to use suppositories, 26.5% had needed to use an enema, and 8% had had a manual evacuation. The use of PAMORAs, and other novel effective medications, was relatively uncommon.

Conclusion: The results of this study suggest that management in Europe is often inadequate, and this undoubtedly relates to a combination of inadequate assessment, inappropriate treatment, and inadequate reassessment.

Keywords: Analgesics; Cancer pain; Neoplasms; Opioid; Opioid-induced constipation.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid* / administration & dosage
  • Analgesics, Opioid* / adverse effects
  • Analgesics, Opioid* / therapeutic use
  • Cancer Pain* / drug therapy
  • Constipation / chemically induced
  • Constipation / drug therapy
  • Constipation / epidemiology
  • Europe
  • Female
  • Humans
  • Laxatives* / administration & dosage
  • Laxatives* / therapeutic use
  • Male
  • Middle Aged
  • Opioid-Induced Constipation*
  • Prevalence
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires

Substances

  • Analgesics, Opioid
  • Laxatives