Laxative management in ambulatory cancer patients on opioid therapy: a prospective, open-label investigation of polyethylene glycol, sodium picosulphate and lactulose

  1. S. WIRZ MD1,*,
  2. J. NADSTAWEK PROFESSOR2,
  3. C. ELSEN MD2,
  4. U. JUNKER MD3,
  5. H.C. WARTENBERG PHD4

Article first published online: 31 AUG 2011

DOI: 10.1111/j.1365-2354.2011.01286.x

Issue

European Journal of Cancer Care

European Journal of Cancer Care

Volume 21, Issue 1, pages 131–140, January 2012

Additional Information

How to Cite

WIRZ, S., NADSTAWEK, J., ELSEN, C., JUNKER, U. and WARTENBERG, H.C. (2012), Laxative management in ambulatory cancer patients on opioid therapy: a prospective, open-label investigation of polyethylene glycol, sodium picosulphate and lactulose. European Journal of Cancer Care, 21: 131–140. doi: 10.1111/j.1365-2354.2011.01286.x

Author Information

  1. 1

    Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, Palliative Medicine, CURA-Hospital, Bad Honnef

  2. 2

    Clinic and Policlinic for Anesthesia and Operative Intensive Care, Outpatients Pain Clinic, University of Bonn, Bonn

  3. 3

    Department of Special Pain Therapy and Palliative Medicine, Sana-Klinikum Remscheid, Ruhr-University Bochum, Remscheid, Germany

  4. 4

    Afdeling anesthesiologie H1-115, Academisch Medisch Centrum, Universiteit van Amsterdam, Amsterdam, the Netherlands

*Stefan Wirz, Department of Anesthesiology, Intensive Care Medicine, Pain Therapy, Palliative Medicine, CURA-Hospital, Schuelgenstr. 15, D-53604 Bad Honnef, Germany (e-mail: stefan.wirz@cura.org; s.wirz@web.de).

  1. Sources of support in the form of grants, bursaries, free use of equipment, drugs or any other benefits: none.

Publication History

  1. Issue published online: 19 DEC 2011
  2. Article first published online: 31 AUG 2011
  3. Accepted 14 July 2011

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Keywords:

  • cancer;
  • constipation;
  • symptoms;
  • pain;
  • supportive care;
  • opioid

WIRZ S., NADSTAWEK J., ELSEN C., JUNKER U. & WARTENBERG H.C. (2012) European Journal of Cancer Care21, 131–140. Laxative management in ambulatory cancer patients on opioid therapy: a prospective, open-label investigation of polyethylene glycol, sodium picosulphate and lactulose

Constipation and the laxatives polyethylene glycol (PEG), sodium picosulphate (SPS) and lactulose (L) were investigated in outpatients with cancer and on opioid therapy. Randomly selected patients were enrolled in a prospective, controlled, open-label trial. Endpoints were number of patients taking laxatives >28 days, number of patients with a stool-free interval >72 h (sfi72), dosage, numerical rating scale (NRS) for constipation, and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QoL) questionnaire scores. The 348 patients had comparable demographic and medical data. In this ambulatory population, mobility scores remained unaffected. Constipation incidence was 5.7%, with sfi72 42, mean NRS 2.3557 and mean QoL 2.1. A total of 53.2% discontinued their laxative medication. Laxative use correlated with higher opioid usage (morphine-equivalent mg/day: no laxative 98.2, SPS 128.2, PEG 139.9, L 154.5). PEG was the most frequently prescribed laxative (PEG 27.3%, SPS 10.3%, L 9.2%). PEG (sfi72 12.6%, NRS 2.2, QoL 2.1) and SPS (sfi72 11.1%, NRS 2.7, QoL 2.2) proved more effective than L (sfi72 15.5%, NRS 3.8, QoL 2.5). In spite of opioid therapy, the incidence of constipation was low in these ambulatory cancer pain patients at an early disease stage. For prevention of constipation, PEG or SPS is recommended instead of L.

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