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. 2021 Jan 2;20(1):1.
doi: 10.1186/s12904-020-00693-z.

Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients

Regina Gironés Sarrió  1 , Agnès Calsina-Berna  2 , Adoración Gozalvo García  3 , José Miguel Esparza-Miñana  4   5 , Esther Falcó Ferrer  6 ; Working Group ActEIO Project; Josep Porta-Sales  7
Collaborators, Affiliations

Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients

Regina Gironés Sarrió et al. BMC Palliat Care. .

Abstract

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical approach of OIC in cancer patient.

Methods: A modified Delphi method was conducted involving 46 different physicians experts in OIC. Using a structured questionnaire of 67 items this project intended to seek consensus on aspects related to diagnosis, treatment, and quality of life of cancer patients suffering with OIC.

Results: After two rounds, a consensus was reached in 91% of the items proposed, all in agreement. Agreement was obtained on OIC definition (95.7%). Objective and patient-reported outcomes included in that definition should be assessed routinely in clinical practice. Responsive to symptom changes and easy-to-use assessment tools were recommended (87.2%). Successful diagnosis of OIC requires increase clinicians awareness of OIC and proactivity to discuss symptoms with their patients (100%). Successful management of OIC requires individualization of the treatment (100%), regular revaluation once is established, and keeping it for the duration of opioid treatment (91.5%). Oral Peripherally Acting μ-Opioid Receptor Agonists (PAMORAs), were considered good alternatives for the treatment of OIC in cancer patients (97.9%). This drugs and laxatives can be co-prescribed if OIC coexist with functional constipation.

Conclusions: The panelists, based on their expert clinical practice, presented a set of recommendations for the management of OIC in cancer patients.

Keywords: Cancer; Constipation; Laxative; Opioid; Pain.

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Conflict of interest statement

Regina Gironés Sarrió received honoraria for participating a an advisory board member for AstraZeneca, Pfizer, Roche, Bristol-Myers Squibb, Eli Lilly, Kyowa Kirin, Tesaro, Nutricia, Nestlé, Boheringuer, and Celgene. Agnès Calsina-Berna received honoraria for participating in the ActEIO project Working Group. Adoración Gozalvo García and José Miguel Esparza-Miñana have no any conflict of interests that may be inappropriately influce this work. Esther Falcó Ferrer has participated in meetings and has been invited to congress from Merck, Amgen, Roche, and Eli Lilly. Josep Porta-Sales has received honoraria for participating in educational activities and research projects from Kyowa Kirin and Ferrer.

Figures

Fig. 1
Fig. 1
Main results of the Delphi consensus
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