A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer.
BACKGROUND
Constipation is a common and distressing condition in patients with cancer, especially those taking opioid analgesics. Many institutions prevent and treat constipation with titrated laxatives, which is known as a bowel protocol. An effective and well-tolerated bowel protocol is a very important component of cancer care, and there is little evidence on which to base selection of the most appropriate agents. This study compares a protocol of the stimulant laxative sennosides alone with a protocol of sennosides plus the stool softener docusate, in hospitalized patients at an oncology center. The docusate-containing protocol had an initial docusate-only step for patients not taking opioids, and four to six 100-mg capsules of docusate sodium in addition to the sennosides for the rest of the protocol.


METHODS
Thirty patients received the sennosides-only (S) protocol and 30 the sennosides plus docusate (DS) protocol. The efficacy and adverse effects of the protocols were monitored for 5-12 days. The two protocols were used sequentially, creating two cohorts, one on each protocol. Eighty percent of patients were taking oral opioids and 72% were admitted for symptom control/supportive care.


RESULTS
Over a total of 488 days of observation it was found that the S protocol produced more bowel movements than the DS protocol, and in the symptom control/supportive care patients this difference was statistically significant (p < 0.05). In the S group admitted for symptom control/supportive care 62.5% had a bowel movement more than 50% of days, as compared with 32% in those receiving the DS protocol. Fifty-seven percent of the DS group required additional interventions (lactulose, suppositories or enemas) compared to 40% in the S group. Cramps were reported equally by 3 (10%) patients in each group. Eight patients (27%) experienced diarrhea in the S group compared to 4 (13%) in the DS group.


CONCLUSIONS
The addition of the initial docusate-only step and adding docusate 400-600 mg/d to the sennosides did not reduce bowel cramps, and was less effective in inducing laxation than the sennosides-only protocol. Further research into the appropriate use of docusate and into the details of bowel protocol design are required.
Hawley
Philippa Helen
PH
Department of Palliative Care, BC Cancer Agency, Vancouver, British Columbia, Canada. pippahawley@shaw.ca
Byeon
Jai Jun
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects; D000880:Anthraquinones / Q000627:therapeutic use*; D003248:Constipation / Q000188:drug therapy* / Q000209:etiology; D004143:Dioctyl Sulfosuccinic Acid / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D012676:Senna Extract; D000081226:Sennosides; D013501:Surface-Active Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000880:Anthraquinones; D054368:Laxatives; D000081226:Sennosides; D013501:Surface-Active Agents; D004143:Dioctyl Sulfosuccinic Acid; D012676:Senna Extract