The purposes of this two phase study are to determine the incidence and trajectory of constipation among cancer patients at risk for constipation, to evaluate the efficacy of the Constipation Treatment Protocol, (Robinson et al., 2000) and compare management according to dose of constipation-inducing medications with management according to on-going assessment.
Aim 1: To identify the incidence, severity, distress and trajectory of constipation in cancer patients receiving opioids over an eight week period and to evaluate the relationships between constipation intensity and opioid dose.
Aim 2: To identify the incidence, severity, distress and trajectory of constipation in groups of cancer patients who may be at risk due to vinca alkaloids (vincristine, vinblastine, vinorelbine and vindesine) over an eight week period and to evaluate the relationship between constipation intensity and vinca alkaloid dose.
Aim 3: To test the efficacy of a Constipation Treatment Protocol in patients with medication-induced constipation.
Public Health Relevance
The large number of patients with advanced cancer who are receiving daily opioids and are at risk for constipation make this a significant problem to study. Cancer statistics show us that more than 550,000 patients will die from cancer this year (ACS, 2007). The vast majority of these will have cancer pain, be treated with opioids, and have constipation as an inevitable result. In addition, a large number of patients receive one of the vinca alkaloids each year to treat their cancers. All of these patients also are at risk for constipation. Thus, a study such as this has the potential to improve care for hundreds of thousands of patients each year.