Management of Opioid-Induced and Non–Opioid-Related Constipation in Patients With Cancer: Systematic Review and Meta-Analysis

Problem Identification: A systematic review and meta-analysis was conducted to inform the development of national clinical practice guidelines on the management of cancer constipation.

Literature Search: PubMed^®, Wiley Cochrane Library, and CINAHL^® were searched for studies published from May 2009 to May 2019.

Data Evaluation: Two investigators independently reviewed and extracted data from eligible studies. The Cochrane Collaboration risk-of-bias tool was used, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence.

Synthesis: For patients with cancer and opioid-induced constipation, moderate benefit was found for osmotic or stimulant laxatives; small benefit was found for methylnaltrexone, naldemedine, and electroacupuncture. For patients with cancer and non–opioid-related constipation, moderate benefit was found for naloxegol, prucalopride, lubiprostone, and linaclotide; trivial benefit was found for acupuncture.

Implications for Practice: Effective strategies for managing opioid-induced and non–opioid-related constipation in patients with cancer include lifestyle, pharmacologic, and complementary approaches.

Supplemental material can be found at https://bit.ly/3c4yewT