Opioid-induced constipation during the last week of life does not influence the well-being of patients or their caregivers, according to results of a study published in Medicine.
Researchers performed an observational, retrospective, non-interventional study using medical and nursing records from the last days of life of 121 patients (mean age, 78.1 years; 69 men) who died in 2021. The researchers aimed to determine the effects of constipation on patients’ symptom control and overall quality of life. The Edmonton scale was used to assess symptom severity, and the palliative outcome scale (POS) was used to assess patients’ quality of life.
The researchers also aimed to determine whether opioid-induced constipation and caregiver fatigue were related to place of death (in hospital vs at home).
Most patients (n=95) in this study were prescribed morphine. Of those patients, 42 were also using another major opioid. A total of 25 patients received treatment with fentanyl, 20 received tapentadol, 13 buprenorphine, and 5 both tapentadol and buprenorphine.
Patients receiving home palliative care were followed for an average of 39.7 days, while patients with cancer received follow-up care for an average of 47 days. Constipation occurred in 97% of patients who received chronic opioid therapy. Overall, constipation was reduced by 55.1% through the implementation of an opioid-induced constipation prevention protocol.
Patients receiving morphine experienced the highest rates of opioid-induced constipation, while those receiving tapentadol experienced the lowest.
Although a majority of patients (82.6%) indicated a preference for spending their last days at home, at-home mortality occurred among only 90 (74%). Of note, the occurrence of in-hospital mortality among patients who preferred to be at home (n=10) was associated with caregiver exhaustion. However, caregiver burden was assessed with the Zarit scale, which did not have a specific cut-off point. Of those who did not spend their last days at home, 15% spent them in a hospital and 11% in an institution.
Study limitations include its unicentric design and small sample size.
“Constipation in the last week of life does not seem to influence the well-being of patients, which is noticeable by the lack of statistical significance between Edmonton and POS of constipated and non-constipated patients. Constipation also had no statistically significant influence on caregiver burden,” according to the researchers. They also suggest that “intensive therapies to control this symptom in the last week of life should be considered only in specific cases in which the general condition worsens.” Opioid-induced constipation may be managed with a conservative approach for patients at the end of life, they concluded.
Ribeiro H, Magalhães J, Cardoso T, et al. Opioids and constipation therapy in the last week of life: Their impact on patients, caregivers, and the location of death. Medicine (Baltimore). Published online January 20, 2023. doi:10.1097/MD.0000000000032718