Management of Opioid-Induced Constipation in Hospice Patients

Abstract

Background: Constipation is a common symptom in patients with advanced disease taking opioids. Opioid-induced constipation (OIC) is commonly treated with laxatives and stool softeners. Recently, newer agents have come to market which broaden options for patients in whom first-line therapies are not effective.

Objective: To determine what pharmacologic regimens are currently used in hospice programs to prevent and treat OIC, whether those regimens have changed with the introduction of newer agents and evidence discouraging the use of docusate, and whether hospice programs are standardizing the management of OIC.

Methods: An online 10-item questionnaire was disseminated by the National Hospice and Palliative Care Organization. Questions addressed demographics; first-, second- and third-line pharmacologic treatments included in bowel protocols; whether prescribing practices have changed in the last 5 years; and percentage of patients receiving specific constipation therapies.

Results: The majority of organizations (68.8%) responded that at least 90% of patients were prescribed a bowel regimen on admission to hospice and 84.4% stated that they have a guideline or protocol for managing OIC. The most commonly used preparations for the treatment of OIC for patients during their length of stay in hospice were senna plus docusate, senna alone, docusate alone, bisacodyl, polyethylene glycol 3350, and lactulose. Over 75% of hospice organizations claimed they never used methylnaltrexone, linaclotide, lubiprostone, or naloxegol.

Conclusion: This survey provides insight into recent practices of hospice organizations in the treatment of OIC. As more agents come to market, it is likely that management of OIC will continue to evolve.

Keywords: hospice; laxatives; opioid-induced bowel dysfunction; opioid-induced constipation; palliative care; peripherally acting µ-opioid antagonists.