Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective
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ORIGINAL ARTICLE
Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study Timothy J. Brown 1 & Neil Keshvani 1 & Arjun Gupta 2 & Hui Yang 3 & Deepak Agrawal 4,5 & Tri C. Le 1,6 & David E. Gerber 1,6,7 & Carlos A. Alvarez 3,7,8 Received: 14 October 2019 / Accepted: 17 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Lung cancer . Supportive care . Palliative care . Opioids
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05364-6) contains supplementary material, which is available to authorized users. * Carlos A. Alvarez [email protected]
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Department of Medicine, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Harold C Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
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Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Pharmacy Department, VA North Texas Health Care System, Dallas, TX, USA
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School of Pharmac
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