A Pilot Real-life Study Opioid Induced Constipation in Neoplastic Patients Admitted to Internal Medicine Ward. Outcome of Naldemedine Therapy According to Available Guidelines

Chiara Valentina Luglio; Agostino Di Ciaula; Silvia Sozzi; Claudia Conforti; Gianluca Bitonto; Piero Portincasa; OIC-BA Study Group

doi:10.15403/jgld-6733

Authors

Chiara Valentina Luglio Division of Internal Medicine ‘A. Murri’ and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari ‘Aldo Moro’
Agostino Di Ciaula Division of Internal Medicine „A. Murri” and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari Aldo Moro, Bari, Italy
Silvia Sozzi Division of Internal Medicine ‘A. Murri’ and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari ‘Aldo Moro’
Claudia Conforti Division of Internal Medicine ‘A. Murri’ and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari ‘Aldo Moro’
Gianluca Bitonto Division of Internal Medicine ‘A. Murri’ and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari ‘Aldo Moro’
Piero Portincasa Division of Internal Medicine ‘A. Murri’ and Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari ‘Aldo Moro’ https://orcid.org/0000-0001-5359-1471
OIC-BA Study Group Anna Belfiore, Pierluigi Carratu, Carlo Custodero, Angela De Luca, Tecla Diana, Antonio Giuliano, Antonino Noto, Anna Romito

DOI:

https://doi.org/10.15403/jgld-6733

Keywords:

opioid-induced constipation, opioid, laxatives, OIC, naldemedine, polyehylene glycol

Abstract

Background and Aims: The use of opioids has expanded significantly worldwide in patients with cancer-related pain. Therefore, opioid-induced constipation (OIC) is emerging as one of the most frequent and distressing gastrointestinal side effects. Despite the high prevalence, OIC is frequently underdiagnosed and inadequately managed, with critical effects on the quality of life of patients.

Methods: The present study assessed the real-life prevalence of opioid use and OIC in 316 consecutive cancer patients hospitalized in an Internal Medicine ward and evaluated the outcomes following PEG or naldemedine during hospitalization. When OIC was diagnosed (Rome IV criteria), all patients underwent polyethylene glycol (PEG). Naldemedine was subsequently administered in refractory OIC.

Results: A total of 82 patients (26% of admissions) were assuming opioids for cancer pain, with constipation diagnosed in 62% and 24% of patients with or without opioid treatment, respectively. The risk of OIC was higher during combined opioids than in monotherapy, and fentanyl was associated with the highest OIC prevalence. Among patients with OIC, 47% responded to polyethylene glycol (PEG), whereas 52.9% started naldemedine 200 micrograms/day for a refractory OIC, with subsequent improvement in 59.3% of cases.

Conclusions: The prevalence of opioid use and OIC is relevant among hospitalized cancer patients. The systematic adoption of standardized diagnostic tools can improve recognition and the clinical management in patients with OIC, in particular in case of refractory OIC. It is essential to increase awareness on this condition and to implement management pathways based on existing guidelines.