ONS Connect - May 2008 - (Page 20)

fivEMiNUTEiNSErviCE As sEEn in tHE CliniCal Journal of onCology nursing Put Evidence Into Practice to Prevent and Manage Constipation in Patients With Cancer [By Pamela Oestreicher, PhD, ONSEdge Scientific Writer] C onstipation is a major source of distress for patients with cancer that significantly affects their quality of life. It can be a side effect of treatment, secondary to disease sequelae, or a preexisting condition. It is often unrecognized, underassessed, and ineffectively managed. Nurses play a key role in the prevention and management of this nursing-sensitive patient outcome and need evidence-based interventions to guide their practice. In the April 2008 issue of the Clinical Journal of Oncology Nursing, Woolery et al. analyzed the existing research as part of the ONS Putting Evidence Into Practice® (PEP) project, with the purpose of identifying evidence-based interventions for the prevention and management of constipation in people with cancer. Although the exact incidence of constipation in the adult oncology population is not known, it has been reported as ranging from 50%–95%, with the highest incidence observed in patients receiving opioids. Five common causes have been identified. • The cancer itself, which can obstruct the bowel, affect the autonomic nervous system, or cause spinal cord compression • Disease effects resulting from illness such as dehydration, spinal cord compression, immobility, or changes in bowel habits Key Definition Constipation: a decrease in the passage of formed stool characterized by stools that are hard and difficult to pass; people with constipation typically have fewer than two to three stools per week and may strain to have a bowel movement; may be accompanied by abdominal pain, nausea, vomiting, abdominal distention, loss of appetite, headache, and dry, hard stools • Previous laxative abuse • Cancer therapies such as vinca alkaloids • Other interventions for symptom management such as opioids or tricyclic antidepressants Prevention and management should be essential components of nursing practice. If constipation is not managed proactively, patients can experience negative consequences such as anorexia, nausea, bowel impaction, or bowel perforation. A variety of pharmacologic and nonpharmacologic interventions are used for the management of this distressing symptom. A majority of the research identified was not conducted specifically in oncology; only eight studies examined the management of constipation in patients with cancer. Because little to no evidence existed for interventions commonly used in practice, and patients can have comorbid reasons for experiencing constipation, the project team decided it was important to review the research related to constipation in the nononcology population. recommendations for patients Because of a lack of evidence, no interventions could be recommended for nursing practice in the oncology population. However, several interventions were categorized as “likely to be effective” based on less well-established evidence (see Figure 1). Strong evidence and guidelines developed by a consensus panel of experts recommend a proactive approach to preventing constipation in patients at highest risk, particularly those receiving medications such as vinca alkaloids, which slow colonic transit times, or opioids. Opioid rotation also has been found to decrease the incidence of constipation. For persistent constipation, the National Comprehensive Cancer Network recommends the use of polyethylene glycol in patients with cancer. Stimulant or osmotic laxatives also were identified as “likely be effective” for persistent constipation at the end of life. Other pharmacologic and nonpharmacologic interventions, including many Five-Minute In-Service is a monthly feature that offers readers a concise recap of a full-length article published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Putting Evidence Into Practice®: Evidence-Based Interventions for the Prevention and Management of Constipation in Patients With Cancer” by Myra Woolery, MN, RN, CPON®, Annette Bisanz, MPH, BSN, RN, Hannah F. Lyons, MSN, RN, BC, AOCN®, Lindsay Gaido, MSN, RN, Mary Yenulevich, BSN, RN, OCN®, Stephanie Fulton, MS, and Susan C. McMillan, PhD, ARNP, FAAN, which is featured in the April 2008 issue of CJON. Questions regarding the information presented in this Five-Minute In-Service should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted. 20 ONS CONNECT MAY 2008

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ONS Connect - May 2008 Contents Editor's Note Just In ONS Leadership Development Institute A Year in the Life - Month Five Web Content Capitol Connection Notice Nursing Now Caregiver Care Put Evidence Into Practice to Prevent and Manage Constipation in Patients With Cancer Giant Database Allows Scientists to Share Information Calendar of Events Working for You Staying on Top

ONS Connect - May 2008

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