The Markers of Constipation in Palliative Care Cancer Patients: A Multicenter Cohort Study

Background: There is no widely approved definition of constipation in palliative care, and short life expectancy allows only for a short time of observation before diagnosis. Apart from the patient’s subjective perception, it should include the objective (measurable) symptoms, as a significant portion of patients is unable to express their subjective assessment. The aim of this study was to verify what is the correlation between the objective and subjective symptoms of constipation and what values are diagnostic to constipation in adult palliative care cancer patients. Methods: A multicenter cohort study was performed. Results: 547 adult cancer patients were routinely assessed by physicians in 12 in-patient, home, and ambulatory palliative care centers. 369 patients met the inclusion criteria. The time since the last spontaneous bowel movements and their frequency were correlated with the subjective measures: the difficulty of defecation, the Bowel Function Index, and the necessity to use laxatives. The difficulty of defecation was moderate to the extreme when the time since the last spontaneous bowel movements was ≥2 days or a frequency of spontaneous bowel movements was <4 per week. Conclusions: Constipation should be diagnosed optimally based on a combination of objective and subjective metrics. At least one of the diagnostic markers should be present: the difficulty of defecation of ≥2 in [0-4] scale (moderately difficult to extremely difficult); the necessity of laxatives to induce bowel movements; time since the last spontaneous bowel movements ≥2 days; frequency of spontaneous bowel movements <4 per week.