Brick, N. (2013). Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Clinical Journal of Oncology Nursing, 17(1), 91–92. 

DOI Link

Purpose

STUDY PURPOSE: To assess the effectiveness of a laxative versus methylnaltrexone for the management of constipation in palliative care patients
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Cochrane Library of Systematic Reviews
 
KEYWORDS: Effectiveness of laxatives, methylnaltrexone 
 
INCLUSION CRITERIA: Randomized clinical trials required to have investigated effectiveness of laxatives or methylnaltrexone; published and unpublished studies; adults; cancer and other chronic diseases
 
EXCLUSION CRITERIA: None noted

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Seven randomized controlled trials (RCTs)
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Review of RCTs with data extraction; meta-analysis was used to provide a pooled estimate effect where the data were of sufficient quality

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 7
  • TOTAL PATIENTS INCLUDED IN REVIEW = 616
  • KEY SAMPLE CHARACTERISTICS: Average age = 61–72 years; patients in advanced stage of diseases in palliative care; four studies examined lactulose, senna, co-danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin; three studies evaluated methylnaltrexone

Phase of Care and Clinical Applications

PHASE OF CARE: End of life care
 
APPLICATIONS: Palliative care

Results

All of the studies investigated variables in laxative types, opioid doses, and frequency of stools. Outcome measures included change in frequency of bowel movements, ease of defection, relief of systemic and abdominal symptoms of constipation, change in quality of life, and the use of rescue laxatives. There were no significant cross-findings, except all participants required rescue laxatives despite the initiation of a constipation prevention regimen. In two studies of (288) participants using methylnaltrexone versus a placebo, a statistically significant difference favored the intervention of rescue-free laxation 4 hours and 24 hours after the first dose of methylnaltrexone. Thirty percent of those participants experienced adverse effects. One study of 33 participants with methylnaltrexone showed a statistical difference favoring higher doses. Adverse effects were similar.

Conclusions

There were no recommendations for optimal laxative management of constipation in palliative care patients.

Limitations

There was little concrete evidence and too many variables across the studies. There was no information on how the search was conducted. It was very difficult to follow the evidence summary.

Nursing Implications

The effectiveness of laxatives and the optimum management of constipation in palliative care patients requires further investigation involving the measurement of standardized, clinically relevant outcomes in a clearly defined population.

Legacy ID

4565