Constipation is a significant risk factor for patients with gastrointestinal cancer and requires additional attention. The constipation risk was assessed in this study using the Chinese version of the Constipation Risk Assessment Scale. The validity and reliability of the CRAS-C have been thoroughly evaluated in our previous study, and the scale's cutoff point is 11. In 190 patients with gastrointestinal cancer, the CRAS-C score was 13.22 ± 4.69. It was, on average, at a high risk of constipation. Among 190 patients, 51 (26.8 percent) had a score of less than 11, indicating a low-risk level of constipation, while 139 (73.2 percent) had a score of 11 or higher, indicating a high-risk level of constipation. In a previous study, the risk of constipation was high in 47.0 percent of 302 patients with multiple cancer diagnoses. On the other hand, patients with gastrointestinal cancer have a higher risk of constipation. This is consistent with studies indicating that constipation is significantly higher in patients with gastrointestinal cancer than in other cancers.
The findings indicated that diet and medication-related factors were the primary risk factors for constipation. Constipation-related risk factors are more prevalent in patients with gastrointestinal cancer, as they are affected by symptoms, examination, and treatment. To begin with, patients with gastric, esophageal, colorectal, and other gastrointestinal cancers frequently experience anorexia, nausea, early satiety, abdominal pain, and other symptoms that impair fiber and water intake. Second, 63.7 percent of patients in this study were treated with anti-tumor medication, while 52.6 percent were treated with chemotherapy. Chemotherapy can result in nausea, vomiting, and loss of appetite, among other side effects.
Additionally, because the food selection in hospitals is limited compared to that at home, fiber, water, and brain intake are reduced during hospitalization. The European Society for Medical Oncology's guidelines for managing constipation in patients with advanced cancer include recommendations for preventing constipation caused by lifestyle factors. These recommendations are also appropriate for patients who have been diagnosed with gastrointestinal cancer. Palliative care is defined as patient- and family-centered care that aims to maximize the quality of life through the prevention, reduction, and treatment of suffering. Palliative care should be available throughout an illness, beginning with diagnosis. Constipation is a common complication for gastrointestinal cancer patients and a significant cause of morbidity and distress that is frequently under-appreciated. Constipation risk assessment and prevention should therefore be performed following disease diagnosis.
Furthermore, the results indicated that the use of analgesics, antiemetics, and chemotherapy drugs increased the risk of constipation in patients with gastrointestinal cancer. Opioid-induced constipation (OIC) is common, with a rate ranging between 40% and 80%, and will not be tolerated with prolonged use[14–16]. According to this study, 26.8% of 190 patients with gastrointestinal cancer used opioids. According to the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for adult cancer pain management, laxatives should be prescribed to patients who take opioids. However, a previous study in Mainland China found that prophylactic laxatives were prescribed at a rate of only 48.5%, implying that OIC prevention is insufficient. Additionally, the prevention and treatment of OIC constipation should be standardized. Chemotherapy is one of the most comprehensive cancer treatments available. Constipation is a common side effect of vinblastine and other chemotherapy drugs. Antiemetics that block 5-HT3 receptors are widely used to prevent and treat chemotherapy-induced nausea and vomiting, with constipation as the primary adverse effect. As a result, chemotherapy patients are more likely to experience constipation. 52.6% of patients in this study received cytotoxic chemotherapy, and 74.7% received antiemetics. As a result, it is critical to develop and implement standardized constipation prevention measures for chemotherapy patients.
Incorporating CRAS into the management pathway of patients with gastrointestinal cancer is essential. Duffy J et al. used a constipation risk assessment tool to identify patients at increased risk of constipation and implemented a constipation prevention strategy in these patients. Constipation was significantly reduced as a result of this intervention. Additionally, previous research showed that CRAS increased physician, nurse, patient, and other health team members' awareness of constipation in cancer patients. Additionally, the effort resulted in developing policy, implementation, and practice changes regarding constipation management in cancer patients at a comprehensive cancer center. In a best practice implementation project for advanced cancer patients in Mainland China, constipation risk assessment tools were identified as the primary impediment to constipation prevention. We previously translated CRAS into Chinese and confirmed the tool's reliability and validity. Thus, CRAS-C could be integrated into the constipation management pathway for patients with gastrointestinal cancer in the future. Targeted preventive measures can be administered based on the results of the constipation risk screening.
Moreover, the results indicated that constipation for the majority of the preceding three months, ascites, and an ECOG score of 1 or greater were all associated with constipation in patients with gastrointestinal cancer. Additionally, we examined the effects of commonly used medications on constipation in gastrointestinal cancer patients but found no significant results. Future research should focus on additional constipation risk factors, the development of a more specific risk assessment tool, and the implementation of constipation prevention programs based on risk assessment in gastrointestinal cancer.
This study has some limitations. First, a convenient sampling technique was used. Even if the sample size was sufficient, the sample representativeness might be poor. Second, because this is a cross-sectional study, it is difficult to grasp the dynamic trajectory of constipation risk change in patients with gastrointestinal cancer.