Constipation Severity And Quality Of Life Among Patients With Cancer Who Received Prophylactic Laxatives: Quasi-Experimental StudyⅢ
Dec 28, 2023
The main finding of this study highlighted the importance of administering the prophylactic first-line laxatives to patients with cancer who had constipation (i.e., Bisacodyl, Dose= 3 tab/ day or Lactulose, Dose = 15 ml three times per day) concurrently with opioid medication. This intervention has decreased constipation severely. Most participants in both groups were constipated (76.8%) at baseline in this study.
This finding is congruent with several other similar studies. (Fine et al., 2019) reported that patients with cancer treated with opioids and had constipation were more than twice as likely as those without constipation. In a previous study conducted among 520 patients with cancer who received opioids, 61.7% of patients reported constipation, and 85.7% of patients were considered constipated as physician evaluation (Abramowitz et al., 2013). Patients with cancer receiving opioid treatment with prophylactic laxatives had a 34% decrease in OIC compared to patients receiving opioid treatment without prophylactic laxatives (Ishihara et al., 2010).
Therefore, the frequency of having OIC may be estimated to elevate among patients with cancer who do not receive laxatives concurrent with prescribed opioids. Strategies must be implemented in practice that prevent or manage OIC, such as harmless and effective first-line laxatives. The findings of this study showed a significant decrease in constipation severity at eight weeks post-intervention among the intervention group, where no improvement was noted in the control group. This indicates that using prophylactic laxatives effectively reduced the constipation incidence when starting opioid treatment.
This result is congruent with another study finding conducted on critically ill patients to assess the effectiveness of prophylactic laxatives on constipation occurrence (Masri et al., 2010). Moreover, Müller-Lissner et al. (2017) analyzed data pooled from two randomized controlled trials, which evaluated the effect of either Bisacodyl (BIS) among 736 patients with chronic constipation, Sodium Picosulfate (SPS) among 468 patients, or placebo. The analysis from the two randomized controlled trials compared the patients in intervention group 468 (who received SPS/BIS); with control group 250 (who received placebo) and showed that patients in the intervention group reported a notable increase in the number of spontaneous bowel movements over four weeks from baseline compared with the control group (Müller-Lissner et al., 2017).
In terms of QoL, patients with cancer who received prophylactic laxatives significantly improved QoL at eight weeks post-intervention compared with patients in the control group. This result is consistent with the results of previous studies (Müller-Lissner et al., 2017). It was shown that the overall score of QoL among patients in the intervention groups was significantly improved compared to a placebo group (47%, and 14.5%, respectively) (MüllerLissner et al., 2017). Further, a survey was conducted on a sample of patients with cancer from the UK, Canada, and Germany to evaluate the magnitude of OIC (Coyne et al., 2016).
It was found that OIC was prevalent, and QoL was severely compromised. However, most patients acknowledged a reduction in OIC and improved QoL after the laxative therapy was initiated (Coyne et al., 2016). Quality of life is more important in cancer care. Previous studies found a high incidence of cancer-related symptoms, including OIC, among Jordanian patients with cancer and poor QoL (Ahmad et al., 2015; Al Qadire and Al Khalaileh, 2014). However, prophylactic manners for the treatment of OIC in patients with cancer would lead to improving QoL. On the other hand, using more than one laxative and prolonged consumption are associated with low QoL (Christensen et al., 2016). The findings of this study should be explained in light of the following limitations. First, study respondents were selected from a single setting. OIC examination and management might be distinct from one setting to another, and thus, the generalization of the results might be limited.
The findings of the current study have several implications for practice. First, oncology nurses and others who work with patients with cancer should perform an early comprehensive evaluation of OIC as soon as possible as it is one of the common and distressing symptoms. Second, nurses need to use their evaluation of patient status to advocate for using laxatives as prophylactics in expectation of OIC development. Finally, nurses are in a distinctive position to advance OIC management as they have a significant role in the healthcare team and stay with patients for a long time. In the research field, educational programs for physicians and nurses about assessment, prevention, and management of OIC require to be verified for their effectiveness and practicability in bedside caring areas.
Using prophylactic laxatives concurrently with opioids could effectively improve adherence to the recommended strategies for the management of OIC. This can be reached through offering educational sessions and material for physicians and nurses about OIC assessment, prevention, and management. However, it is necessary to test such an intervention for effectiveness and feasibility in clinical practice settings. Furthermore, knowledgeable and aware healthcare providers are considered a main source of information for patients; accordingly, they must educate patients about the significance of laxative consumption in avoiding the incidence and the treatment of OIC. Patients would likely cooperate and follow the management plan if they experience decreasing therapeutic complications such as constipation.
In conclusion, this study assessed the impacts of prophylactic laxatives on constipation severity and QoL among patients with cancer. Besides severity, many patients with cancer have developed OIC and have poor QoL. It can be concluded that the benefits of using prophylactic first-line laxatives together with opioids are extended to reduce the severity of OIC and enhance the QoL for patients with cancer. Therefore, prophylactic laxatives are advised to be prescribed once the opioid treatment is started.
Natural Herbal Medicine For Relieving Constipation-Cistanche
Cistanche is a genus of parasitic plants that belongs to the family Orobanchaceae. These plants are known for their medicinal properties and have been used in Traditional Chinese Medicine (TCM) for centuries. Cistanche species are predominantly found in arid and desert regions of China, Mongolia, and other parts of Central Asia. Cistanche plants are characterized by their fleshy, yellowish stems and are highly valued for their potential health benefits. In TCM, Cistanche is believed to have tonic properties and is commonly used to nourish the kidney, enhance vitality, and support sexual function. It is also used to address issues related to aging, fatigue, and overall well-being. While Cistanche has a long history of use in traditional medicine, scientific research on its efficacy and safety is ongoing and limited. However, it is known to contain various bioactive compounds such as phenylethanoid glycosides, iridoids, lignans, and polysaccharides, which may contribute to its medicinal effects.
Wecistanche's cistanche powder, cistanche tablets, cistanche capsules, and other products are developed using desert cistanche as raw materials, all of which have a good effect on relieving constipation. The specific mechanism is as follows: Cistanche is believed to have potential benefits for relieving constipation based on its traditional use and certain compounds it contains. While scientific research on Cistanche's effect on constipation is limited, it is thought to have multiple mechanisms that may contribute to its potential to relieve constipation. Laxative Effect: Cistanche has long been used in Traditional Chinese Medicine as a remedy for constipation. It is believed to have a mild laxative effect, which can help promote bowel movements and induce constipation. This effect may be attributed to various compounds found in Cistanche, such as phenylethanoid glycosides and polysaccharides. Moistening the Intestines: Based on traditional use, Cistanche is considered to have moisturizing properties, specifically targeting the Intestines. Promoting hydration and lubrication of the Intestines may help soften tools and facilitate easier passage, thereby relieving constipation. Anti-inflammatory Effect: Constipation can sometimes be associated with inflammation in the digestive tract. Cistanche contains certain compounds, including phenylethanoid glycosides and lignans, that are believed to have anti-inflammatory properties. By reducing inflammation in the intestines, it may help improve bowel movement regularity and relieve constipation.
