Background: Opioid-induced constipation (OIC) is a common distressing symptom
associated with cancer pain opioid treatment. Beyond the recommendations for the treatment
of OIC, there are no specific guidelines for the management of the patient with OIC
and little is known about the decision tree health care professional (HCP) use to manage
OIC. The ECOFoundation (Excellence andQuality inOncology) has promoted this study
to learn about the diagnostic and treatment criteria ofOIC in clinical practice.
Methods: An on-line survey was completed by 135 investigators: 122 medical oncologists
(90.4%) and 13 palliative care specialists (9.6%). The questionnaire included 50
items about the management of OIC.
Results: According to HCP, most of the cancer patients with pain (71.2%), received
opioid treatment for more than 6 months and 54.4% developed OIC. Although 97% of
HCP considered OIC as a major health problem only 14.8% of HCP used algorithms
for the diagnosis of OIC and 14.1% for OIC treatment. Laxatives were considered second-
line treatment for 60% of HCP, after healthy life-style recommendations.
Laxatives were prescribed by 99.3% of HCP, but only 38.3% recommended them
throughout the opioid treatment period. HCP considered laxatives did not achieve a
therapeutic response on 33% of the cases. Peripherally Active m-Opioid Receptor
Antagonist (PAMORA) were considered by 80% of HCP a good alternative for the specific
treatment of OIC in cancer patients. Indeed, PAMORA were considered the most
effective measure with a score of 8 out of a 10 points scale.
Conclusions: OIC is considered a frequent and relevant opioid side effect among cancer
patients in Spain. Although most HCP are aware of the potential for OIC with
opioid treatment, there is limited consensus on the OIC diagnostic and treatment criteria.
The insufficient efficacy of traditional therapies and the emerging of more specific
and effective pharmacological approaches, suggest new clinical guidelines are needed
for the management of OIC in cancer patients.
Legal entity responsible for the study: ECO Foundation.