Feudtner, C., Freedman, J., Kang, T., Womer, J.W., Dai, D., & Faerber, J. (2014). Comparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: A multicenter study of clinically detailed administrative data. Journal of Pain and Symptom Management, 48, 272–280. 

To compare patients who receive senna with similar patients who receive other oral bowel medications; to determine the subsequent risk of problematic constipation, assessed as the occurrence of the enemas, escalation of oral bowel medications, and abdominal imaging

Retrospective matched study of hospitalized pediatric patients with cancer from 78 hospitals from 2006–2011 who were started on seven consecutive days or more of opioid therapy and were started on an oral bowel medication within two days of starting the opioid therapy, were evaluated to look at the use of the effectiveness of senna in the regimen. Data were collected from a pediatric health information system and premier perspective databases.

• N = 245 (blood cancer), 295 (solid tumor cancer)  
• AGE = 0–20 years
• FEMALES: Eligible for matching: unexposed 50%, exposed 50%; matched cohort: unexposed 50%, exposed 50%
• KEY DISEASE CHARACTERISTICS: Brain, blood, solid

• SITE: Multi-site    
• SETTING TYPE: Inpatient    
• LOCATION: 78 hospitals

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Pediatrics

• Retrospective-matched sampling

• Data were collected from a pediatric health information system and premier perspective databases.

Initiating senna therapy within two days of starting prolonged opioid course compared with initiating another bowel medication had a significantly lower hazard ratio of requiring enemas (HR = 0.01; 95% CI [0.11, 0.91]) or the need for the patient to require radiographic imaging (HR = 0.74; 95% CI [0.55, 0.98]) or escalation or oral bowel medication (HR = 0.78; 95% CI [0.59, 1.03]). Overall, senna had a lower hazard composite endpoint of problematic constipation (HR = 0.7; 95% CI [0.56, 0.88]).

Senna was more effective than other oral medications at improving constipation in pediatric patients with cancer. Patients required fewer enemas and less radiographic imaging. Patients on senna did not require as much dose escalation to control constipation.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

Senna is an effective prophylactic bowel regimen for pediatric patients requiring prolonged opioid therapy.