Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study.
Purpose: Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined p...
| Published in: | Supportive Care in Cancer Vol. 28; no. 11; pp. 5315 - 5322 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
| Published: |
Springer Nature
Nov2020
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146367567&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 146367567 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09414355 O1J jtl: Supportive Care in Cancer issn: 09414355 maglogo: N pubinfo: dt: Nov2020 vid: 28 iid: 11 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 146367567 144050222 146367567 NLM32124025 10.1007/s00520-020-05364-6 NLM32124025 146367567 ppf: 5315 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study. aug: au: Brown, Timothy J. Keshvani, Neil Gupta, Arjun Yang, Hui Agrawal, Deepak Le, Tri C. Gerber, David E. Alvarez, Carlos A. affil: Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA sug: subj: Cathartics Therapeutic Use Chemoprevention Statistics and Numerical Data Veterans Statistics and Numerical Data Lung Neoplasms Drug Therapy Retrospective Design Aged Adult Palliative Care Statistics and Numerical Data Middle Age Analgesics, Opioid Adverse Effects Prospective Studies Palliative Care Methods Cross Sectional Studies Lung Neoplasms Epidemiology Chemoprevention Methods Male Pain Therapy Female Aged: 65+ years Adult: 19-44 years Middle Aged: 45-64 years Male Female ab: Purpose: Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined patterns of prescription of laxative agents in patients with lung cancer initiating opioids.Methods: We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer seen in the Veteran's Affairs (VA) system, between January 1, 2003, and December 31, 2016. Exposure to laxative agents was categorized as follows: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis.Results: Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis and 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while all other categories of OIC prophylaxis were unchanged. We noted an inverse relationship with OIC prophylaxis and likelihood of a diagnosis of constipation at 3 and 6 months.Conclusions: In this study of veterans with lung cancer, almost 90% received inadequate or inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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