title: A comparison of sennosides-based bowel protocols with and without docusate in hospitalized patients with cancer.
abstract: 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.
authors.affiliation: Department of Palliative Care, BC Cancer Agency, Vancouver, British Columbia, Canada. pippahawley@shaw.ca
authors.forename: Philippa Helen
authors.initials: PH
authors.lastname: Hawley
authors.forename: Jai Jun
authors.initials: JJ
authors.lastname: Byeon
mesh_terms: 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
chemical_list: D000701:Analgesics, Opioid; D000880:Anthraquinones; D054368:Laxatives; D000081226:Sennosides; D013501:Surface-Active Agents; D004143:Dioctyl Sulfosuccinic Acid; D012676:Senna Extract