5556 - Consensus on strategies in the management of opioid-induced constipation in cancer patients

Background

Patients with cancer under opioid treatment often develop opioid-induced constipation (OIC). Despite the high prevalence, medical management of OIC is often uncertain. This study sought to gather the opinion of experts in opioid use and OIC to reach a consensus on diagnosis and treatment strategies.

Methods

A modified Delphi method was conducted involving multidisciplinary experts. The resulting questionnaire addressed OIC diagnosis, OIC treatment, and quality of life of patients with cancer and OIC.

Results

A consensus in agreement was reached in almost all items (91%). Most of the panelists agreed that, although common (87.2%), the diagnosis of OIC in patients with cancer is difficult because of the limited knowledge of its pathophysiological features (80%). In patients with cancer, OIC control improves pain treatment adherence, which in turn improves their quality of life (95.7%). For effective diagnosis, experts recommend healthcare professionals to proactively ask patients under opioid treatment about the symptoms of OIC (100%). Occasionally, patients only report symptoms of OIC when these are severe (85.1%). Additionally, the experts recommended a complete patient’s clinical history (95.7%) with special focus on previous functional constipation (93.6%) that should be treated before opioid therapy begins (76.6%). For the specific treatment of OIC in patients with cancer most of the panelists agree that laxatives are not often effective (78.7%) and, according to clinical practice, it is recommended to take oral Peripherally Acting µ-Opioid Receptor Antagonists (PAMORAs; e.g. naloxegol) along with the prescribed laxative (80%). Furthermore, the management of OIC should start as soon as possible since the treatment is more complicated with stablished OIC and severe symptoms (95.7%). Regarding hygienic-dietary recommendations the panel agreed that, although necessary, they are not sufficiently effective (91.5%).

Conclusions

OIC needs to be specifically managed to improve the quality of life of patients with cancer. This modified Delphi consensus considered expert opinions in the search of therapeutic strategies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Kyowa Kirin Farmaceutica.

Funding

Kyowa Farmaceutica S.L.U. Spain.

Disclosure

R. Girones Sarrio: Advisory / Consultancy: Kyowa Kirin Farmaceutica; Advisory / Consultancy: Roche; Travel / Accommodation / Expenses: Sanofi; Advisory / Consultancy: Pfizer; Advisory / Consultancy: MSD. E. Falcó: Advisory / Consultancy: Kyowa Kirin Farmaceutica. A. Gozalvo: Advisory / Consultancy: Kyowa Kirin Farmaceutica. J.M. Esparza Miñana: Advisory / Consultancy: Kyowa Kirin Farmaceutica. A. Calsina-Berna: Advisory / Consultancy: Kyowa Kirin Farmaceutica. J. Porta Sales: Advisory / Consultancy: Kyowa Kirin Farmaceutica.