ONS Connections: Opioid-induced constipation inadequately addressed

PHOENIX—Opioid-induced constipation is not adequately addressed by nurse practitioners and physicians, according to research presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference. This type of constipation can be severe and cause distress, so nurse practitioners should take the time to assess this common problem and manage it.

Constipation is a common problem in cancer patients and is a nurse-sensitive outcome. Though constipation is amenable to nursing intervention, it often goes unrecognized and untreated in oncology settings. When constipation is not managed, serious complications can occur.

Oncology nurse practitioners face a significant problem because research on which to base treatment decisions is lacking for opioid-induced constipation. This study sought to determine the severity and trajectory of constipation among patients with a variety of types of cancer who were at risk for constipation due to opioids. A total of 255 patients from an NCI-designated comprehensive cancer center were contacted weekly by telephone for 8 weeks to assess their symptoms.

Of the participants, 55% were women; 65% were married; 85.5% were non-white Hispanic; and 55% had completed some college. The common common cancer types included lymphoma (24%), lung cancer (18%), breast cancer (16%), and leukemia (10%), reported Susan McMillan, PhD, ARNP, FAAN, during her presentation at the meeting.

Symptoms were assessed based on intensity, distress, and timing. The Constipation Assessment Scale (0-16) was used to assess the presence and severity of constipation, and the Memorial Symptom Assessment Scale (0-4) was used to assess distress caused by pain and constipation.

Though constipation intensity did decline over the 8 weeks, the change was less than one point on a scale of 1-16, which was clinically insignificant. Patients continued to have constipation throughout the 8 weeks. The researchers attributed the small decrease to the fact that patients were being asked every week if they were constipated and whether they were taking laxatives. This may have led some patients to self-treat. A total of 63% of participants reported experiencing some level of constipation.

Severe constipation (16 on a scale from 0-16) was experienced by some patients for 8 weeks, and high levels of associated distress (6 on a scale from 0-10) were also reported. A correlation was found between symptom intensity and distress (r=.76; P=.000). While these variables of symptom intensity and distress were related, they are both different concepts that each deserve attention.

The findings suggest that nurse practitioners could easily manage the prevalent problem of opioid-induced constipation. Further, the possible severity and distress associated with this condition suggest that time should be spent to assess and manage it.

By Kathy Boltz PhD

PHOENIX—Opioid-induced constipation is not adequately addressed by nurse practitioners and physicians, according to research presented at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference. This type of constipation can be severe and cause distress, so nurse practitioners should take the time to assess this common problem and manage it.

Constipation is a common problem in cancer patients and is a nurse-sensitive outcome. Though constipation is amenable to nursing intervention, it often goes unrecognized and untreated in oncology settings. When constipation is not managed, serious complications can occur.

Oncology nurse practitioners face a significant problem because research on which to base treatment decisions is lacking for opioid-induced constipation. This study sought to determine the severity and trajectory of constipation among patients with a variety of types of cancer who were at risk for constipation due to opioids. A total of 255 patients from an NCI-designated comprehensive cancer center were contacted weekly by telephone for 8 weeks to assess their symptoms.

Of the participants, 55% were women; 65% were married; 85.5% were non-white Hispanic; and 55% had completed some college. The common common cancer types included lymphoma (24%), lung cancer (18%), breast cancer (16%), and leukemia (10%), reported Susan McMillan, PhD, ARNP, FAAN, during her presentation at the meeting.

Symptoms were assessed based on intensity, distress, and timing. The Constipation Assessment Scale (0-16) was used to assess the presence and severity of constipation, and the Memorial Symptom Assessment Scale (0-4) was used to assess distress caused by pain and constipation.

Though constipation intensity did decline over the 8 weeks, the change was less than one point on a scale of 1-16, which was clinically insignificant. Patients continued to have constipation throughout the 8 weeks. The researchers attributed the small decrease to the fact that patients were being asked every week if they were constipated and whether they were taking laxatives. This may have led some patients to self-treat. A total of 63% of participants reported experiencing some level of constipation.

Severe constipation (16 on a scale from 0-16) was experienced by some patients for 8 weeks, and high levels of associated distress (6 on a scale from 0-10) were also reported. A correlation was found between symptom intensity and distress (r=.76; P=.000). While these variables of symptom intensity and distress were related, they are both different concepts that each deserve attention.

The findings suggest that nurse practitioners could easily manage the prevalent problem of opioid-induced constipation. Further, the possible severity and distress associated with this condition suggest that time should be spent to assess and manage it.

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