A Longitudinal Study of Predictors of Constipation Severity in Oncology Outpatients with Unrelieved Pain

• Published in: Journal of pain and symptom management Vol. 59; no. 1; pp. 9 - 19.e1
• Main Authors: Valenta, Sabine, MScN, Spichiger, Elisabeth, RN, PhD, Paul, Steven M, Rabow, Michael W., MD, Plano Clark, Vicki L., PhD, Schumacher, Karen L., RN, PhD, Miaskowski, Christine, RN, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020; Elsevier Limited
• Subjects: Aged; Analgesics; Analgesics - therapeutic use; Anesthesia; bowel movement; Cancer; cancer pain; Cancer Pain - complications; Cancer Pain - drug therapy; Constipation; Constipation - diagnosis; Constipation - epidemiology; Constipation - etiology; Female; hierarchical linear modeling; High risk; Humans; laxatives; Linear analysis; Longitudinal Studies; Male; Middle Aged; Oncology; opioids; Outpatient care facilities; Outpatients; Pain; Pain Medicine; Prevalence; Risk Factors; Severity; Severity of Illness Index; Side effects; Surveys and Questionnaires; constipation; cancer pain; hierarchical linear modeling; bowel movement; laxatives; opioids; Constipation
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2019.08.027

AbstractContextWhile constipation is a common symptom in oncology patients, it often goes unrecognized and untreated. In addition, little is known about characteristics associated with inter-individual differences in constipation severity. ObjectivesDescribe prevalence, characteristics, and management of constipation; evaluate for inter-individual differences in constipation severity over ten weeks; and identify demographic, clinical, and symptom characteristics associated with higher constipation severity scores. MethodsIn this prospective, longitudinal study, 175 oncology patients with unrelieved pain were recruited from eight outpatient cancer settings in the United States. Patients completed demographic and symptom questionnaires at enrollment. Constipation severity was evaluated over ten weeks using the Constipation Assessment Scale (CAS). Hierarchical linear modeling was used to identify characteristics associated with higher CAS scores. ResultsAt enrollment 70.1% of the patients reported constipation (i.e., CAS score of >2; mean CAS score: 3.72; ±3.11). While over the first week of the study, patients used one to two constipation treatments per day, a large amount of inter-individual variability was found in CAS scores. Higher percentage of days with no bowel movement (BM), higher number of constipation treatments, higher state anxiety scores, and higher analgesic side effects scores were associated with higher CAS scores at enrollment. Higher percentage of days with no BM was associated with inter-individual differences in the trajectories of constipation. ConclusionOur findings underscore the high prevalence of and large amount of inter-individual variability in constipation severity. The characteristics associated with worse CAS scores can assist clinicians to identify high risk patients and initiate prompt interventions.