Moxibustion as Supportive Therapy for Opioid-Induced Constipation in Patients with Advanced Cancer: A Case Series

Opioid-induced constipation (OIC) is a common adverse effect of opioid therapy in cancer patients, often persisting despite laxatives and peripherally acting μ-opioid receptor antagonists. Moxibustion, a traditional thermal therapy applied to acupuncture points, has been proposed as a supportive option, but clinical evidence for OIC remains scarce. This study evaluated the clinical outcomes and feasibility of moxibustion for OIC in advanced cancer patients.

We conducted a prospective case series at Kagawa University Hospital (April 2023-July 2025). Ten patients with advanced cancer and clinically diagnosed OIC were included. Eligibility required Eastern Cooperative Oncology Group performance status 0-2 and no prior chronic constipation. Moxibustion was delivered twice weekly for three weeks (six sessions) to standardized abdominal, hand, and foot acupoints using a ceramic warming device. Constipation severity was assessed with the Constipation Assessment Scale (CAS). Secondary outcomes included laxative use, stool form, and Edmonton Symptom Assessment System-Revised.

Eight patients improved in CAS scores (mean change -2.8, SD: 3.0; p = 0.012) and sustained it at four-week follow-up (-2.5, SD: 2.7; p = 0.022). All patients reduced laxative use, and several achieved normalization of stool form. No treatment-related adverse events occurred.

This case series indicates moxibustion is a feasible and safe complementary therapy for OIC in advanced cancer, with the potential to reduce symptom burden and medication use. While limited by small sample size and lack of control, the findings support further trials to confirm its role in integrative palliative care.