CONSTIPATION IN ADVANCED CANCER-PATIENTS

Constipation is a frequent, distressing, and underestimated complicati on in patients with advanced cancel: It may develop from general distu rbances that may or may not be cancer related, but the use of opioids is one of the main causes in this population. Opioids affect the intes tine by reducing motility and secretions and by increasing fluid absor ption and blood flow. Untreated constipation may lead to several compl ications. Effective management of constipation starts with a careful a ssessment of the patient, including the history of the frequency and d ifficulty of defaecation, symptoms caused by constipation, and physica l and rectal examinations. When the diagnosis of constipation is uncle ar, an abdominal X-ray may be required. The treatment of constipation includes general interventions, such as the availability of comfort an d privacy or the elimination of medical factors that may contribute to constipation, and therapeutic interventions including oral or rectal laxatives and the use of prokinetic drugs and naloxone. The purpose of this paper is to review the pathophysiology and causes of constipatio n and the effects of opioids on the gastrointestinal tract, and to pro pose an approach for its assessment and management. Randomized clinica l trials between different laxatives and/or prokinetic agents in cance r patients are needed, and future studies should focus on the validati on of different clinical assessment tools for constipation.