Investigation of Constipation Frequency and Development Risk in Cancer Patients

Öz

Background: Constipation is one of the common symptoms in cancer patients, and many factors such as lack of mobility, insufficient fluid intake, chemotherapy, radiotherapy and opioid use can be effective in this symptom. Close monitoring of cancer patients in terms of the risk of developing constipation contributes to the early diagnosis of this symptom. Objectives: The aim of this study is to determine the frequency / risk of development and some factors affecting the development of constipation in cancer patients hospitalized in the oncology clinic. Methods: This descriptive study in October 2018-February 2019, between the age of 18, was conducted with 129 patients who were diagnosed with cancer. The data were collected using 'Individual Identification Form' and 'Constipation Risk Assessment Scale'. The evaluation of the data was done by Chi-square, Mann-Whitney U test. Results: The mean age of the patients is 59 ± 1.12 years, 34.2% are women, 65.8% are men and frequency of constipation is 62%. It has been determined that there is a statistically significant difference between the patients being construed and continuous opioid treatment, the reason for hospitalization and the presence of metastasis. Constipation rate was higher in patients who were constantly receiving opioid therapy and hospitalized for supportive treatment (p < .05). It was found that the risk of developing constipation was moderate level (13.1 ± 4.3) in patients who were not constipated. Conclusion: In our study, it was determined that the majority of patients hospitalized in the oncology clinic experienced constipation, continuous opioid treatment, supportive treatment and the presence of metastasis were effective in patients' constipation and cancer patients who were not constipated were at moderate risk.

Anahtar Kelimeler

• Oncology
• Constipation
• Nursing

Kanser Hastalarında Konstipasyon Sıklığı ve Gelişme Riskinin İncelenmesi

Öz

Giriş: Konstipasyon kanser hastalarında sık görülen semptomlardan biri olup, bu semptomun görülmesinde hareket azlığı, yetersiz sıvı alımı, kemoterapi, radyoterapi gibi tedavi yöntemleri ve opioid kullanımı gibi birçok faktör etkili olabilmektedir. Kanser hastalarının konstipasyon gelişme riski açısından yakından izlenmesi bu semptomun erken dönemde tanılanmasına katkı sağlar. Amaç: Bu çalışmanın amacı onkoloji kliniğinde yatan kanser hastalarında konstipasyon sıklığı/gelişme riski ve konstipasyon gelişmesini etkileyen bazı faktörlerin belirlenmesidir. Yöntem: Tanımlayıcı nitelikteki bu çalışma Ekim 2018-Şubat 2019 tarihleri arasında 18 yaşından büyük, kanser tanısı almış 129 hasta ile yürütülmüştür. Veriler ‘Birey Tanılama Formu’ ve ‘Konstipasyon Risk Değerlendirme Ölçeği’ kullanılarak toplanmıştır. Verilerin değerlendirilmesi Ki-kare, Mann-Whitney U testi analizi ile yapılmıştır. Bulgular: Hastaların yaş ortalaması 59 ± 1.12 yıl, %34.2 'si kadın, %65.8 'i erkek ve konstipasyon görülme sıklığı %62’dir. Hastaların konstipe olmasında sürekli opioid tedavisi alma, hastaneye yatış nedeni ve metastaz varlığına göre istatistiksel olarak anlamlı bir farklılık olduğu belirlenmiştir. Sürekli opioid tedavisi alan ve destek tedavi almak amaçlı hastaneye yatan hastalarda konstipasyon oranı daha yüksekti (p < .05). Konstipe olmayan hastaların ise konstipasyon gelişme riskinin orta düzeyde (13.1 ± 4.3) olduğu saptanmıştır. Sonuç: Çalışmamızda onkoloji kliniğinde yatan hastaların çoğunluğunun konstipasyon yaşadığı, sürekli opioid tedavisi alma, destek tedavi alma ve metastaz varlığının hastaların konstipasyon yaşamasında etkili olduğu ve konstipe olmayan kanser hastalarının ise orta düzeyde risk altında olduğu belirlenmiştir.

Anahtar Kelimeler

• Onkoloji
• Konstipasyon
• Hemşirelik

Kaynakça

1. 1. Wickham RJ. Managing constipation in adults with cancer. J Adv Pract Oncol 2017;8(2):149-61.
2. 2. Gonzales LK, Delmastro MA, Boyd DM, Sterling ML, Aube PA, Le RN, et al. Adjusting bowel regimens when prescribing opioids in women receiving palliative care in the acute care setting. Am J Hosp Palliat Care 2016;33(7):663-8.
3. 3. McIlfatrick S, Muldrew DHL, Beck E, Carduff E, Clarke M, Finucane A, et al. Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care: a multi-site retrospective case note review of clinical practice. BMC Palliat Care 2019;18(1):57. 4. Sayın Kasar K, Yıldırım Y. Konstipasyon. İçinde: Yıldırım Y, Fadıloğlu Ç, Palyatif Bakım Semptom Yönetimi ve Yaşam Sonu Bakım. Ankara: Nobel Tıp Kitabevleri; 2017: 533-548.
4. 5. Lam WC, Zhong L, Liu Y, Shi N, Ng B, Ziea E et al. Hong Kong Chinese medicine clinical practice guideline for cancer palliative care: pain, constipation, and insomnia. Evid Based Complement Alternat Med 2019; 1-14.
5. 6. Zhe H. The assesment and management of constipation among patients with advanced cancer in a palliative care ward in china: a best practice implementation project. JBI Database of System Rev Implement Rep 2016;14(5):295-309.
6. 7. Bengi G, Yalçın M, Akpınar H. Kronik konstipasyona güncel yaklaşım. Güncel Gastroenteroloji 2014;18(1):72-88.
7. 8. Uysal N, Şenel G, Karaca Ş, Kadıoğulları N, Koçak N, Oğuz G. Palyatif bakım kliniğinde yatan hastalarda görülen semptomlar ve palyatif bakımın semptom kontrolüne etkisi. Klinik çalışma. Ağrı Dergisi 2015; 27(2):104-10.
8. 9. Karadakovan A. Yaşlı Sağlığı ve Bakım. Ankara: Akademisyen Tıp Kitabevi; 2014: 279-95.

9. 10. Sendir M, Büyükyilmaz F, Asti T, Gürpınar S. Postoperative constipation risk assessment in Turkish orthopedic patients. Gastroenterol Nurs 2012; 35(2):106-13. 11. Cochran WG. Sampling techniques. New York: John Wiley & Sons; 1977: 1-448. ISBN: 978-0-471-16240-7.
10. 12. Lindberg G, Hamid SS, Malfertheiner P, Thomsen OO, Fernandez LB, Garisch J et al. World Gastroenterology Organisation global guideline: constipation—a global perspective. J Clin Gastroenterol 2011;45(6):483-487.
11. 13. Richmond JP, Wright ME. Review of the literature on constipation to enable development of a constipation risk assessment scale. Clin Eff Nurs 2004;9(1-2):37–48.
12. 14. Kutlu Koca A, Yılmaz E, Çeçen D, Eser E. The reliability and validity of the turkish version of the constipation risk assessment scale. Gastroenterol Nurs 2010;34(3):200-8.
13. 15. Hagmann C, Cramer A, Kestenbaum A, Durazo C, Downey A, Russel M et al. Evidence-based palliative care approaches to non-pain physical symptom management in cancer patients. Semin Oncol Nurs 2018;34(3):227-40.
14. 16. Arthur J, Hui D. Safe opioid use: management of opioid-related adverse effects and aberrant behaviors. Hematol Oncol Clin North Am 2018;32(3):387-403.
15. 17. Veiga DR, Mendonça L, Sampaio R, Lopes JC, Azevedo LF. Incidence and health related quality of life of opioid-ınduced constipation in chronic noncancer pain patients: a prospective multicentre cohort study. Pain ResTreat 2018; 2018:5704627.
16. 18. Larkin PJ, Cherny NI, La Carpia D, Guglielmo M, Ostgathe C, Scotte F et al. ESMO Guidelines Committee. Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29(4):111-25.
17. 19. Dzierżanowski T, Ciałkowska-Rysz A. The occurrence and risk factors of constipation in inpatient palliative care unit patients vs. nursing home residents. Prz Gastroenterol 2018; 13(4): 299-304.
18. 20. Boland JW, Elaine G. Pharmacological therapies for opioid induced constipation in adults with cancer. Bmj 2017; 358: j3313.
19. 21. Abramowıtz L, Beziaud N, Labreze L, Giardina V, Causse C, Chuberre B et al. Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: Dyonısos study. J Med Econ 2013; 16.12: 1423-1433.
20. 22. Younes WO, Tawalbeh LI. Bowel management: constipation among patients with cancer. J Palliat Care Med 2017;(7)4.
21. 23. Locasale RJ, Datto CJ, Margolis MK, Tack J, Coyne KS. The impact of opioid‐induced constipation among chronic pain patients with sufficient laxative use. Int J Clin Pract 2015; 69.12: 1448-1456.
22. 24. Wang PM, Hsu CW, Liu CT, Lai TY, Tzeng FL, Huang CF. Effect of acupressure on constipation in patients with advanced cancer. Support Care Cancer 2019; 1-6.
23. 25. Celik S, Atar NY, Ozturk N, Mendes G, Kuytak F, Bakar E et al. Constipation risk in patients undergoing abdominal surgery. Iran Red Crescent Med J 2015;17(6).
24. 26. Lavan AH, O'Mahony D, Buckley M, O'Mahony D, Gallagher P. Adverse drug reactions in an oncological population: prevalence, predictability, and preventability. Oncologist 2019; 24(9): e968.
25. 27. Dzierżanowski T, Ciałkowska-Rysz A. Behavioral risk factors of constipation in palliative care patients. Supportive Care Cancer 2015; 1787-1793.
26. 28. Wickham RJ. Assessment of constipation in patients with cancer. J Adv Pract Oncol 2016;7(4):457–62.
27. 29. İlaslan E, Özer Z, Kol E. Kolorektal kanserlerde palyatif bakım hemşireliği. JAREN/ Hemşirelik Akademik Araştırma Dergisi 2017;3(1):43-8.