Efficacy of naloxegol on symptoms and quality of life related to opioid-induced constipation in patients with cancer: a 3-month follow-up analysis

Objectives: Opioid-induced constipation (OIC) can affect up to 63% of all patients with cancer. The objectives of this study were to assess quality of life as well as efficacy and safety of naloxegol, in patients with cancer with OIC. Methods: An observational study was made of a cohort of patients with cancer and with OIC exhibiting an inadequate response to laxatives and treated with naloxegol. The sample consisted of adult outpatients with a Karnofsky performance status score ≥50. The Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) and the Patient Assessment of Constipation Symptoms (PAC-SYM) were applied for 3 months. Results: A total of 126 patients (58.2% males) with a mean age of 61.3 years (range 34-89) were included. Clinically relevant improvements (>0.5 points) were recorded in the PAC-QOL and PAC-SYM questionnaires (p<0.0001) from 15 days of treatment. The number of days a week with complete spontaneous bowel movements increased significantly (p<0.0001) from 2.4 to 4.6 on day 15, 4.7 after 1 month and 5 after 3 months. Pain control significantly improved (p<0.0001) during follow-up. A total of 13.5% of the patients (17/126) presented some gastrointestinal adverse reaction, mostly of mild (62.5%) or moderate intensity (25%). Conclusions: Clinically relevant improvements in OIC-related quality of life, number of bowel movements and constipation-related symptoms were recorded as early as after 15 days of treatment with naloxegol in patients with cancer and OIC, with a good safety profile

Delirium en cuidados paliativos oncológicos: revisión

We review some aspects related with the physiopathology, epidemiology, diagnosis and management of delirium, centred in patients with advanced and terminal cancer. It is offereda comprehensive and practical overview of this clinical situation frequently underdiagnosticated , specially in the case of patients with far-advanced cancer, in whom it is specially frequent and reversible quite often out the last days of life. We emphasize an interdisplinary approach including family as key in diagnosis and treatment. Pharmacological treatment is up dated and some future line of work are mentioned.Se revisan aspectos relacionados con la fisiopatología, epidemiología, diagnostico y manejo del delirium. Se intenta aportar una visión global y practica de un cuadro clínico frecuentemente infradiagnosticado, especialmente en el contexto del paciente con cáncer avanzado y terminal, donde su frecuencia es elevada y hay altas posibilidades de revertirlo, fuera de la situación de agonía. Se enfatiza un abordaje interdisciplinar que incluya a la familia en todo el proceso diagnostico y terapéutico. Así mismo, se ofrece información actualizada sobre el manejo farmacológico y algunas de las líneas de trabajo ahora iniciadas