Rates of appropriate laxative prophylaxis for opioid-induced constipation in veterans with lung cancer: a retrospective cohort study

Timothy J. Brown, Neil Keshvani, Arjun Gupta, Hui Yang, Deepak Agrawal, Tri C. Le, David E. Gerber, Carlos A. Alvarez

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Purpose: Opioid-induced constipation (OIC) is the most common side effect in patient-prescribed opioids for cancer pain treatment. Current guidelines recommend routine prescription of a laxative for preventing OIC in all patients prescribed an opioid unless a contraindication exists. We determined patterns of prescription of laxative agents in patients with lung cancer initiating opioids. Methods: We performed a retrospective cohort study evaluating the prescription of laxatives for OIC to adult patients with incident lung cancer seen in the Veteran’s Affairs (VA) system, between January 1, 2003, and December 31, 2016. Exposure to laxative agents was categorized as follows: none, docusate monotherapy, docusate plus another laxative, and other laxatives only. Prevalence of OIC prophylaxis was analyzed using descriptive statistics. Linear regression was performed to identify time trends in the prescription of OIC prophylaxis. Results: Overall, 130,990 individuals were included in the analysis. Of these, 87% of patients received inadequate prophylaxis (75% no prophylaxis and 12% docusate alone), while 5% received OIC prophylaxis with the unnecessary addition of docusate to another laxative. Through the study period, laxative prescription significantly decreased, while all other categories of OIC prophylaxis were unchanged. We noted an inverse relationship with OIC prophylaxis and likelihood of a diagnosis of constipation at 3 and 6 months. Conclusions: In this study of veterans with lung cancer, almost 90% received inadequate or inappropriate OIC prophylaxis. Efforts to educate physicians and patients to promote appropriate OIC prophylaxis in combination with systems-level changes are warranted.

Original languageEnglish (US)
Pages (from-to)5315-5321
Number of pages7
JournalSupportive Care in Cancer
Issue number11
StatePublished - Nov 1 2020
Externally publishedYes

Bibliographical note

Funding Information:
Supported in part by a National Cancer Institute (NCI) Midcareer Investigator Award in Patient-Oriented Research (K24 CA201543-01, to D.E.G.), a National Institute of Diabetes and Digestive and Kidney Diseases Career Development Award (K08 DK101602, to C.A.A.), Agency for Healthcare Research and Quality (R24HS022418, to C.A.A.), Cancer Prevention and Research Institute of Texas (170003, to C.A.A.) and the UT Southwestern Center for Translational Medicine (UL1 TR001105 to C.A.A.)

Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Lung cancer
  • Opioids
  • Palliative care
  • Supportive care


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