SAN DIEGOA multidisciplinary group of nurses at New York’s Memorial
Sloan-Kettering Cancer Center have developed a standard of care for cancer
patients suffering from decreased quality of life due to constipation.
Anne Walsh, RN, MS, OCN, a clinical nurse at the Evelyn H. Lauder Breast
Center at Memorial Sloan-Kettering, presented her team’s strategy at the 26th
Annual Conference of the Oncology Nursing Society (abstract 99).
"The project started several years ago," Ms. Walsh said. "We
tried to identify a quality-of-life issue that affected prac-tices throughout
ambulatory care. We identified constipation as a problem that affected all
patients in approximately 95% of their treatment of disease at some
The primary causes of constipation, she said, include decreased physical
activity and inadequate dietary fiber and fluid intake. Additional causes can
be attributed to age; opioids, vinca alkaloids, and other constipating
medications; and a variety of other medical conditions, such as intestinal
obstruction, spinal cord compression, electrolyte imbalance, and depression.
Constipation can result not only in a physical discomfort that negatively
affects quality of life but also in excessive use of health care resources with
unnecessary visits to the emergency room.
The group realized the issue was more multidisciplinary than they had
anticipated, and so they brought in the ser-vices of pharmacy and patient
management, which included pain management, a physician liaison who would
approve the protocol, and other nurse experts.
"We found very little research literature on constipation management
that was noteworthy, but there was a lot of anecdotal information
available," Ms. Walsh pointed out. "So, from the beginning, even
though it was a utilization review project, it really became a practice project
for patient improvement."