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.