Clinical use of oral laxatives in palliative care services in Spain

This study was aimed at evaluating the clinical use of laxatives in palliative care treatment, their overall effectiveness, and their relationship to opioid treatment.

A cross-sectional prospective study on patients attended by 21 palliative care teams on two pre-determined dates was carried out. The variables analyzed were demographic data, underlying disease, functional status, laxative use, use of enemas, concomitant opioid medication, and bowel movements.

Of the 283 patients studied, 54 (19%) have had three or fewer bowel movements per week in the 3 weeks prior to the study, 53 patients (19%) were using rectal measures, 177 patients (63%) were being treated with opioids, and 164 patients (58%) were taking laxatives. Sixty seven percent (119/177) of the patients being treated with opioids were also being treated with laxatives, as were 43% (45/106) of those not receiving opioid treatment. The laxative most used was lactulose (65%). Only 10% used the most recommended combination of an osmotic or softener laxative mixed with another stimulant laxative. Some 24% of patients used enemas or micro enemas in addition to laxatives, 14 patients treated their constipation without laxatives, using only rectal measures.

The clinical practice of the use of oral laxatives in palliative care in our environment differs widely from that recommended in the literature. Further studies are required to confirm if a revision of clinical guidelines are required.