Clinical use of oral laxatives in palliative care services in Spain

Abstract

Objectives: This study was aimed at evaluating the clinical use of laxatives in palliative care treatment, their overall effectiveness, and their relationship to opioid treatment.

Population and method: A cross-sectional prospective study on patients attended by 21 palliative care teams on two pre-determined dates was carried out. The variables analyzed were demographic data, underlying disease, functional status, laxative use, use of enemas, concomitant opioid medication, and bowel movements.

Results: Of the 283 patients studied, 54 (19%) have had three or fewer bowel movements per week in the 3 weeks prior to the study, 53 patients (19%) were using rectal measures, 177 patients (63%) were being treated with opioids, and 164 patients (58%) were taking laxatives. Sixty seven percent (119/177) of the patients being treated with opioids were also being treated with laxatives, as were 43% (45/106) of those not receiving opioid treatment. The laxative most used was lactulose (65%). Only 10% used the most recommended combination of an osmotic or softener laxative mixed with another stimulant laxative. Some 24% of patients used enemas or micro enemas in addition to laxatives, 14 patients treated their constipation without laxatives, using only rectal measures.

Conclusion: The clinical practice of the use of oral laxatives in palliative care in our environment differs widely from that recommended in the literature. Further studies are required to confirm if a revision of clinical guidelines are required.