Recommendations for the Management of Constipation in Cancer Patients

Constipation is a common condition that is often overlooked among cancer patients particularly those with advanced disease. It is often associated with distressing or debilitating symptoms that adversely impact the quality of life of these patients. Hence, it is imperative that practicing clinicians are cognizant of the various etiologies of constipation especially those that are secondary to both cancer therapies and supportive care. Since discontinuation of the offending drug(s) may not be a viable option in the hematology/oncology setting, patient counseling and initiation of preventative measures which include scheduled bowel regimens for therapies known to cause constipation are central to optimal management. As constipation goes unresolved or becomes more severe laxative therapy should be optimized to achieve resolution of symptoms. In severe and refractory cases of constipation consulting a gastrointestinal specialist may be prudent. Herein, we highlight the most common laxative therapies that may be considered in adult cancer patients experiencing initial and refractory constipation as well as provide practical considerations and a management algorithm that can be easily applied or implemented in clinical practice.