Study of Opioid-Induced Constipation 2 Project

NCT ID: NCT04404933

Last Updated: 2020-05-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-08-21

Study Completion Date

2019-08-30

Brief Summary

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The aim of the project is to investigate OIC in a real world / diverse group of patients with cancer.

The objectives of the project are to determine: a) efficacy of a treatment algorithm to manage OIC; b) efficacy of conventional laxatives to manage OIC; c) efficacy of PAMORAs / other interventions to manage OIC.

Detailed Description

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StOIC-2 is an observational study of routine clinical practice, and will involve four assessments over a period of 28 days (3 face to face; 1 telephone). Participants for StOIC 2 study will be identified from StOIC 1 study (CancerTrials.gov registry reference number - NCT04350112). Visit 1 for StOIC 2 study will correspond to the assessment for StOIC 1 study.

Patients will be managed according to a treatment algorithm (see below), which is based on a review of the evidence (and which is the basis of the Multinational Association for Supportive Care in Cancer (MASCC) guideline on the treatment of constipation in patients with advanced cancer). The decision to change treatment is based on efficacy / lack of efficacy (as determined by the Bowel Function Index (see below), or the development of adverse effects.

Step 1: Conventional Laxatives

* Choice of laxatives at the discretion of the clinical team
* Combination of softener and stimulant laxative
* Laxatives to be prescribed on a regular basis

Step 2: Peripherally acting mu opioid receptor antagonist (PAMORA)

* Choice of PAMORA at the discretion of clinical team
* Either oral naloxegol or subcutaneous methylnaltrexone
* PAMORA to be prescribed on a regular basis

Step 3: PAMORA + Conventional Laxatives

* Choice of combination at the discretion of the PI/clinical team
* Combination to be prescribed on a regular basis

Step 4: Other options

\- Choice of other option at discretion of clinical team:

* Bowel cleansing preparations (e.g. Picolax)
* Suppositories
* Enemas
* Manual evacuation
* Other drugs (e.g. lubiprostone, prucalopride)

The following data will be collected: a) demographic data - age, gender, ethnicity; b) cancer diagnosis; c) opioid medications - drug, formulation, dose; d) laxative medications - drug, formulation, dose (every visit); e) Eastern Cooperative Oncology Group performance status.

The participants will also be asked to complete;

1. Bowel Function Index (BFI) - every visit. The BFI is a validated, 3 item, patient reported tool for assessing the treatment of OIC. A BFI score of \> 30 indicates suboptimally treated OIC.
2. Patient Assessment of Constipation - Quality of Life Questionnaire (PAC-QOL) - first and last visit. The PAC-QOL is a validated, 28 item, patient reported tool for assessing the impact of constipation over time.
3. Memorial Symptom Assessment Scale - Short Form (MSAS-SF) - first and last visit. The MSAS-SF is a validated, 32 item, patient reported tool for assessing physical and psychological symptoms in cancer patients.

Data will also be collected on adverse effects from medication / interventions, and reasons for withdrawal from the study.

Conditions

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Opioid-induced Constipation Cancer Cancer Pain

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Interventions

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Treatment algorithm for OIC

Treatment Algorithm for OIC

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* As per StOIC 1: age \> 18yr; diagnosis of cancer; diagnosis of cancer pain; receipt of regular opioids for at least one week
* Diagnosis of OIC as defined by the Rome IV criteria (Lacy et al, 2016)
* Diagnosis of inadequately treated OIC as defined by BFI \> 30

Exclusion Criteria

* As per StOIC 1: inability to give informed consent; inability yo complete questionnaire
* Prognosis \> 1 month
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Kyowa Hakko Kirin UK, Ltd.

INDUSTRY

Sponsor Role collaborator

Royal Surrey County Hospital NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Andrew Davies, MD

Role: PRINCIPAL_INVESTIGATOR

Consultant Palliative Medicine

Locations

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Royal Cornwall Hospital

Truro, Cornwall, United Kingdom

Site Status

Brighton & Sussex University Hospitals

Brighton, East Sussex, United Kingdom

Site Status

Leckhampton Court Hospice

Cheltenham, Gloucestershire, United Kingdom

Site Status

Hospice of St. Francis

Berkhamstead, Hertfordshire, United Kingdom

Site Status

Heart of Kent Hospice

Maidstone, Kent, United Kingdom

Site Status

Wisdom Hospice

Rochester, Kent, United Kingdom

Site Status

St. Raphael's Hospice

Cheam, London, United Kingdom

Site Status

Nottingham University Hospitals

Nottingham, Nottinghamshire, United Kingdom

Site Status

St Margaret's Hospice

Yeovil, Somerset, United Kingdom

Site Status

St. Giles Hospice

Lichfield, Staffordshire, United Kingdom

Site Status

Royal Surrey County Hospital

Guildford, Surrey, United Kingdom

Site Status

Birmingham St. Mary's Hospice

Birmingham, West Midlands, United Kingdom

Site Status

St. Catherine's Hospice

Crawley, West Sussex, United Kingdom

Site Status

St. Gemma's Hospice

Leeds, Yorkshire, United Kingdom

Site Status

Wheatfields Hospice

Leeds, Yorkshire, United Kingdom

Site Status

St. Luke's Hospice

Sheffield, Yorkshire, United Kingdom

Site Status

Countries

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United Kingdom

References

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Davies A, Leach C, Caponero R, Dickman A, Fuchs D, Paice J, Emmanuel A. MASCC recommendations on the management of constipation in patients with advanced cancer. Support Care Cancer. 2020 Jan;28(1):23-33. doi: 10.1007/s00520-019-05016-4. Epub 2019 Aug 9.

Reference Type RESULT
PMID: 31396746 (View on PubMed)

Rentz AM, Yu R, Muller-Lissner S, Leyendecker P. Validation of the Bowel Function Index to detect clinically meaningful changes in opioid-induced constipation. J Med Econ. 2009;12(4):371-83. doi: 10.3111/13696990903430481.

Reference Type RESULT
PMID: 19912069 (View on PubMed)

Argoff CE, Brennan MJ, Camilleri M, Davies A, Fudin J, Galluzzi KE, Gudin J, Lembo A, Stanos SP, Webster LR. Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation. Pain Med. 2015 Dec;16(12):2324-37. doi: 10.1111/pme.12937. Epub 2015 Nov 19.

Reference Type RESULT
PMID: 26582720 (View on PubMed)

Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol. 2005 May;40(5):540-51. doi: 10.1080/00365520510012208.

Reference Type RESULT
PMID: 16036506 (View on PubMed)

Chang VT, Hwang SS, Feuerman M, Kasimis BS, Thaler HT. The memorial symptom assessment scale short form (MSAS-SF). Cancer. 2000 Sep 1;89(5):1162-71. doi: 10.1002/1097-0142(20000901)89:53.0.co;2-y.

Reference Type RESULT
PMID: 10964347 (View on PubMed)

Davies AN, Leach C, Butler C, Patel SD, Shorthose K, Batsari K. Opioid-induced constipation: a stepwise treatment algorithm feasibility study. BMJ Support Palliat Care. 2023 Dec 7;13(e2):e446-e453. doi: 10.1136/bmjspcare-2020-002754.

Reference Type DERIVED
PMID: 34348942 (View on PubMed)

Other Identifiers

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StOIC-2 Project

Identifier Type: -

Identifier Source: org_study_id

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