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MASCC recommendations on the management of constipation in patients with advanced cancer

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Abstract

Purpose

The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer.

Methods

These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The recommendations were categorised by the level of evidence and a “category of guideline” based on the level of evidence (i.e. “recommendation”, “suggestion”, or “no guideline possible”).

Results

The group produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation.

Conclusions

These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.

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Author information

Authors and Affiliations

  1. Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK

    Andrew Davies & Charlotte Leach

  2. Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

    Ricardo Caponero

  3. Royal Liverpool Hospital, Liverpool, UK

    Andrew Dickman

  4. Kepler University Hospital, Linz, Austria

    David Fuchs

  5. Northwestern University, Chicago, IL, USA

    Judith Paice

  6. University College London Hospitals, London, UK

    Anton Emmanuel

Authors
  1. Andrew Davies
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  2. Charlotte Leach
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  3. Ricardo Caponero
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  4. Andrew Dickman
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  5. David Fuchs
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  6. Judith Paice
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  7. Anton Emmanuel
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Corresponding author

Correspondence to Andrew Davies.

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Conflict of interest

ADavies has received personal fees and research funding from Kyowa Kirin; CL has received personal fees from Kyowa Kirin; ADickman has received personal fees from Kyowa Kirin; DF has received personal fees from Novartis, Pfizer, and Roche.

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Appendices

Appendix 1. Medline search strategy

  1. 1.

    Constipation—mesh

OR (search terms 2–50)

  1. 2.

    Defecation—mesh

  2. 3.

    Laxatives—mesh

  3. 4.

    Cathartics—mesh

  4. 5.

    Aperients—keyword

  5. 6.

    Bulk forming laxatives—keyword

  6. 7.

    Ispaghula husk—keyword

  7. 8.

    Methylcellulose—mesh

  8. 9.

    Sterculia—mesh

  9. 10.

    Frangula—mesh

  10. 11.

    Chloride channel agonists—mesh

  11. 12.

    Lubiprostone—mesh

  12. 13.

    Osmotic laxatives—keyword

  13. 14.

    Lactulose—mesh

  14. 15.

    Macrogol—keyword

  15. 16.

    Polyethylene glycols—mesh

  16. 17.

    Magnesium hydroxide—mesh

  17. 18.

    Sodium acid phosphate—keyword

  18. 19.

    Serotonin 5-HT4 receptor agonists—mesh

  19. 20.

    Prucalopride—keyword

  20. 21.

    Stimulant laxatives—keyword

  21. 22.

    Bisacodyl—mesh

  22. 23.

    Co-danthramer—keyword

  23. 24.

    Dantron—keyword

  24. 25.

    Poloxamer—mesh

  25. 26.

    Co-danthrusate—keyword

  26. 27.

    Glycerol—mesh

  27. 28.

    Senna—keyword

  28. 29.

    Senna extract—mesh

  29. 30.

    Senna plant—mesh

  30. 31.

    Anthraquinones—mesh

  31. 32.

    Sodium picosulfate—keyword

  32. 33.

    Opioid receptor antagonists—keyword

  33. 34.

    Narcotic antagonists—mesh

  34. 35.

    Peripherally acting mu-opioid receptor antagonist—keyword

  35. 36.

    Methylnaltrexone—keyword

  36. 37.

    Naloxegol—keyword

  37. 38.

    Softening drugs—keyword

  38. 39.

    Arachis oil—keyword

  39. 40.

    Docusate sodium—keyword

  40. 41.

    Dioctyl sulfosuccinic acid—mesh

  41. 42.

    Liquid paraffin—keyword

  42. 43.

    Mineral oil—mesh

  43. 44.

    Bowel cleansing—keyword

  44. 45.

    Enema—mesh

  45. 46.

    Suppositories—mesh

  46. 47.

    Dietary fiber—mesh

  47. 48.

    Psyllium—keyword

  48. 49.

    Fecal impaction—mesh

  49. 50.

    Disimpaction—keyword

AND (search terms 51–52)

  1. 51.

    Neoplasms—mesh

OR

  1. 52.

    Cancer—keyword

Appendix 2. MASCC criteria for grading recommendations

Table 4 Levels of evidence
Full size table
Table 5 Categories of guidelines
Full size table

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Davies, A., Leach, C., Caponero, R. et al. MASCC recommendations on the management of constipation in patients with advanced cancer. Support Care Cancer 28, 23–33 (2020). https://doi.org/10.1007/s00520-019-05016-4

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