A cross-sectional study of constipation and laxative use in advanced cancer patients: insights for revision of current practice.
OBJECTIVE
This study aimed to evaluate the bowel habit and laxative use in advanced cancer patients with constipation in palliative care unit.


METHODS
It was a cross-sectional study using a self-designed questionnaire.


RESULTS
A total of 225 patients were analysed. Among all patients, 92.0 % (207 patients) had any intervention for relief of constipation, including laxatives, suppositories, enemas, digital evacuation and Chinese herbal medicine, and 65.3 % (147 patients) were on laxatives prescribed by our doctors. The severity of constipation as assessed by the constipation visual analogue scale (CVAS) (0-7, 7 = most severe) was reported as no constipation (0-1) in 19.6 % of patients, constipation (2-4) in 50.7 % and severe constipation (5-7) in 29.8 %. More patients with severe constipation, as compared with patients with constipation and no constipation, reported inadequate pushing force (83.6 vs. 47.4 vs. 6.8 %), sense of incomplete defecation (40.3 vs. 14.9 vs. 6.8 %) and difficult defecation (58.2 vs. 26.3 vs. 0 %), all p < 0.001, but there was no difference in stool types as assessed by Bristol Stool Scale (p = 0.303). Patients not on opioids, as compared with patients on strong opioids, had similar CVAS scores and description of constipation but had least laxatives prescribed (60.2 vs. 78.9 %, p = 0.012).


CONCLUSIONS
Evaluation of constipation should not rely on stool form or consistency alone, and patient's description of constipation is worth consideration. Constipation is also a problem in patients not on opioids and more attention is required. A revisit to existing guidelines is needed.
Yan Chai Hospital-Hong Kong Baptist University Clinical Centre for Training and Research in Chinese Medicine (West Kowloon), Hong Kong, SAR, China.
Chung Wah
CW
Cheng
Annie Ol
AO
Kwok
Zhao Xiang
ZX
Bian
Doris Mw
DM
Tse
D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D015897:Comorbidity; D003248:Constipation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D054368:Laxatives; D008297:Male; D008516:Medicine, Chinese Traditional; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy; D010166:Palliative Care; D017410:Practice Guidelines as Topic
D000701:Analgesics, Opioid; D054368:Laxatives