CLINICAL PRACTICE EVALUATION OF OPIOID INDUCED CONSTIPATION MANAGEMENT IN ONCOLOGIC PATIENTS: THE EIO-50 PROJECT Salvador Bofill , Vicente Guillem , Margarita Feyjoo , Antonio Antón , Enrique Aranda , Carlos Camps , Alfredo Carrato , Manuel Constenla , Juan J. Cruz-Hernández , Eduardo Díaz Rubio , 11 12 13 14 15 Jesus Garcia-Foncillas , Pedro Gascón , Rafael López , Begoña Soler , Yolanda Escobar 1
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MD, Servicio de Oncología. Hospital Virgen del Rocío, Sevilla. 2MD, Fundación ECO, Servicio de Oncología. Instituto Valenciano de Oncología. 3MD, Fundación ECO, Servicio de Oncología. Hospital Universitario La Moraleja Sanitas, Madrid. 4MD, Fundación ECO, Servicio de Oncología Médica. Hospital Universitario Miguel Servet, Zaragoza. 5MD, Fundación ECO, Servicio de Oncología. Hospital Universitario Reina Sofía, Córdoba. 6MD, Fundación ECO, Servicio de Oncología. Hospital General Universitario de Valencia. 7MD, Fundación ECO, Servicio de Oncología. Hospital Universitario Ramón y Cajal, Madrid. 8MD, Fundación ECO, Servicio de Oncología Médica, Hospital Provincial de Pontevedra. 9MD, Fundación ECO, Servicio de Oncología Médica, Complejo Asistencial Universitario de Salamanca. 10MD, Fundación ECO, Vicepresidente de la Real Academia de Medicina, IdISCC, CIBERONC. 11MD, Fundación ECO, Servicio de Oncología Médica, Fundación Jiménez Díaz, Madrid. 12MD, Fundación ECO, Oncología Molecular y traslacional, Institut d’investigacions Biomèdiques August Pi i Sunyer. 13 MD, Fundación ECO, Servicio de Oncología Médica, Hospital Clínico Universitario de Santiago de Compostela. 14MD, E-C-BIO, S.L., Departamento Médico, Las Rozas, Madrid. 15MD, Fundación ECO, Servicio de Oncología. Hospital Universitario Gregorio Marañón, Madrid 1
Opioid-induced constipation (OIC) is a common distressing symptom associated with cancer pain opioid treatment. Recommendations for the treatment of OIC are limited, there are no specific guidelines for the management of OIC in cancer patients and little is known about the decision tree health care professional (HCP) use to manage OIC. The ECO Foundation (Excellence and Quality in Oncology) has promoted this study to learn about the diagnostic and treatment criteria of OIC in cancer patients in clinical practice.
METHODS An on-line survey was completed by 135 investigators: 122 medical oncologists (90.4%) and 13 palliative care specialists (9.6%). The questionnaire included 50 items about the management of OIC.
According to HCP, most of the cancer patients with pain (71.2%), received opioid treatment for more than 6 months and 54.4% developed OIC. Although 97% of HCP considered OIC as a major health problem only 14.8% of HCP used algorithms for the diagnosis of OIC and 14.1% for OIC treatment. Laxatives were considered second-line treatment for 60% of HCP, after healthy life-style recommendations (Figure 1). Laxatives were prescribed by 99.3% of HCP, but only 38.3% recommended them throughout the opioid treatment period. HCP considered laxatives did not achieve a therapeutic response on 33% of the cases (Table 1). Peripherally Active µ-Opioid Receptor Antagonist (PAMORA) were considered by 80% of HCP a good alternative for the specific treatment of OIC in cancer patients. Indeed, PAMORA were considered the most effective measure with a score of 8 out of a 10 points scale (Figure 2). Naloxegol was the most frequent PAMORA used for the treatment of OIC in cancer patients (92,4%). Table 1. Proportion of patiens with no response to traditional treatment or intervention for the management of OIC.
135 Investigators
90.4% +
MEDICAL ONCOLOGIST
#3623. ESMO 2018, 19-23 October, Munich, Germany
9.6% PALLIATIVE CARE SPECIALIST
Nº of investigators
No response % (95% CI)
Healthy life-style
135
52.3 (48.3-56.3)
Laxatives
135
32.6 (29.7-35.4)
Enemas
131
23.4 (19.7-27.1)
Suppositories
109
31.5 (27.3-35.8)
Adjustment of the opioid dose
108
32.2 (27.1-37.3)
Change of opioid
127
28.7 (24.9-32.5)
*Study sponsored by Kyowa Kirin Farmacéutica
Line of treatment (mean, 95% CI)
RESULTS
5 4 3 2 1 0
Healthy life-style
Laxatives
Enemas
Suppositories
Adjustment of opioid dose
Change of opioid
Figure 1. Line of treatment, order of preference for the traditional management of OIC. Efficacy considered (mean, 95%CI)
BACKGROUND
6
10 8 6 4 2 0
Healthy life-style
Laxatives
Enemas
Suppositories
PAMORAs
Adjustment of opioid dose
Change of opioid
Figure 2. Efficacy of treatments and interventions for the management of OIC. Scores in a 10 points scale.
CONCLUSIONS OIC is a frequent opioid side effect and is considered a major health problem among cancer patients in Spain. Although most HCP are aware of the potential for OIC with opioid treatment, there is limited consensus on the OIC diagnostic and treatment criteria. The insufficient efficacy of traditional therapies and the emerging of more specific and effective pharmacological approaches, such as PAMORAs, suggest new clinical guidelines are needed for the management of OIC in cancer patients.
Corresponding author:
[email protected] 
