Prevalence and management of constipation in pediatric acute lymphoblastic leukemia in U.S. children's hospitals

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Jennifer A Belsky1, Joseph R Stanek1, Sarah H O'Brien1,2

  • 1Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio.

Pediatric Blood & Cancer
|September 7, 2020
PubMed

Insights

Constipation affects over a third of children with acute lymphoblastic leukemia (ALL) during induction. Younger age, female sex, longer hospital stays, and opioid use are key risk factors, necessitating proactive management strategies.

Area of Science:

  • Pediatric Oncology
  • Gastroenterology
  • Clinical Pharmacy

Background:

  • Children with acute lymphoblastic leukemia (ALL) often experience chemotherapy-induced side effects.
  • Constipation is a prevalent gastrointestinal issue in pediatric ALL patients, exacerbated by vinca alkaloids, environmental factors, and opioid analgesia.

Purpose of the Study:

  • To investigate the prevalence, risk factors, and treatment patterns of constipation in hospitalized children diagnosed with ALL.
  • To identify key variables associated with constipation in this vulnerable pediatric population.

Main Methods:

  • Retrospective analysis of data from 48 children's hospitals within the Pediatric Health Information System.
  • Inclusion criteria: patients aged 1-21 years with ALL hospitalized between October 2015 and September 2019.
  • Multivariate logistic regression was employed to identify risk factors for constipation.

Main Results:

  • Constipation was diagnosed in 33.9% of patients during ALL induction admission and 19.8% in post-induction admissions.
  • Polyethylene glycol was the most common treatment (89.6%), followed by senna (32.8%), lactulose (24.2%), and docusate (24.2%).
  • Significant risk factors included younger age (<6 years), female sex, increased length of hospitalization, and non-fentanyl opioid use (>2 days).

Conclusions:

  • A substantial proportion of hospitalized children with ALL experience constipation, requiring pharmacologic intervention.
  • Constipation prophylaxis and treatment require increased attention in pediatric ALL patients, especially during induction therapy.
Abstract

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