Greatest research achievements in Kent, Surrey and Sussex: tackling constipation in patients with cancer

To celebrate 10 years of the NIHR Clinical Research Network, we are looking back at our greatest research achievements over the past decade. This includes Kent, Surrey and Sussex-led research studies and those delivered in the region whose results have influenced and impacted clinical practice within the NHS and social care, locally and nationally.

This week's focus is on StOIC, a cancer study looking into opioid induced constipation (OIC) in patients with advanced cancer.

What sites in KSS recruited to this study?

Royal Surrey NHS Foundation Trust (Guildford), Royal Sussex County Hospital (Brighton), Heart of Kent Hospice (Aylesford), St. Catherine’s Hospice (Crawley), St. Raphael’s Hospice (Cheam), Wisdom Hospice (Rochester).

How many participants were recruited?

1007 participants took part in the UK.

What was the background?

Constipation affects many patients using opioids to relieve pain. However, there was limited evidence about this problem, and whether or not current treatments were effective.

What was the study investigating?

The objectives of the study were to determine how common OIC was in people with advanced cancer, its impact on their day-to-day life, and how effective and tolerated were their prescribed laxatives.

What approach was taken for this study?

The study was divided into two parts, and took place in hospitals, hospices and community healthcare settings. The first part (study 1) consisted of one visit by a palliative care specialist, and participants were asked to complete a series of questions about their bowel habit, and treatment for constipation. 1007 participants were involved in study 1.

The second part (study 2) investigated the effectiveness of a treatment guidelines for OIC. 100 participants from study 1, identified as having OIC that was inadequately treated, were invited to take part in study 2. It consisted of four visits over four weeks. At each visit, participants completed a short questionnaire and if they remained constipated, their treatment was escalated.

In this next section, we spoke to Professor Andrew Davies, Professor of Palliative Medicine at Trinity College Dublin and Chief Investigator for StOIC.

Andrew, what were the results and what did we learn?

“The results of study 1 showed that constipation is very common in advanced cancer patients receiving opioids to manage their pain, that the constipation is associated with a variety of other physical problems, and that prescribed treatments are often inadequate. One of the main findings was that patients don’t often realise that they are constipated, and so healthcare professionals need to properly question patients about changes in their bowel function including questions about needing to strain, and consistency of stool.

“In study 2, we found that at the end of 4 weeks, 72% of patients had an improvement in their constipation (with many now not experiencing constipation). Importantly, this improvement occurred after simply changing or increasing regular medication for constipation, and closely monitoring the response to changes.”

Why was this study so important?

“Cancer pain is very common and affects over half of people with cancer. Opioids are often used to manage cancer pain, and constipation is the most common ongoing problem related to these drugs. The StOIC studies provide real world evidence of the burden of this problem and highlight ways of improving the assessment and management of this manageable condition. It should lead to better treatment of patients with constipation, and so improvements in their quality of life.”

What’s next?

“Next, we would like to undertake a large study to confirm the results of study two. This study will look not only at changes in bowel function, but also other important outcomes such as changes in symptoms and quality of life.”