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.

中文翻译：

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肺癌退伍军人中阿片类药物引起的便秘的适当泻药预防率：一项回顾性队列研究。

目的 阿片类药物引起的便秘 (OIC) 是患者使用阿片类药物治疗癌症疼痛时最常见的副作用。目前的指南建议，除非存在禁忌症，否则所有服用阿片类药物的患者均应常规开出泻药来预防 OIC。我们确定了肺癌患者使用阿片类药物的泻药处方模式。方法 我们进行了一项回顾性队列研究，评估 2003 年 1 月 1 日至 2016 年 12 月 31 日期间，在退伍军人事务部 (VA) 系统中发现的患有肺癌的成年患者的 OIC 泻药处方。如下：无，多库酯单一疗法，多库酯加另一种泻药，以及仅其他泻药。使用描述性统计分析 OIC 预防的患病率。进行线性回归以确定 OIC 预防处方的时间趋势。结果 总体而言，分析纳入了 130,990 人。其中，87% 的患者接受了不充分的预防（75% 没有预防，12% 单独使用多库酯），而 5% 的患者接受了 OIC 预防，但在另一种泻药中不必要地添加了多库酯。在整个研究期间，泻药处方显着减少，而所有其他类别的 OIC 预防措施均保持不变。我们注意到 OIC 预防与 3 个月和 6 个月时诊断便秘的可能性呈负相关。结论 在这项针对患有肺癌的退伍军人的研究中，几乎 90% 的人接受了不充分或不适当的 OIC 预防。有必要努力教育医生和患者，结合系统层面的改变，促进适当的 OIC 预防。