Palliative medicine reports · 2026
Naldemedine Initiation Timing after Oxycodone Start and Early Laxative Adjustment in Cancer Care: A Retrospective Cohort Study.
СтатьяНазвание и аннотация: Перевод в очереди
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Kajiura Shinya, Chikaoka Shingo, Yagi Yuta, Ryu Nobukazu, Nakayama Yurika, Sakumura Miho, Ueda Yuko, Motoo Iori, Ando Takayuki, Yasuda Ichiro, Kato Atsushi, Hayashi Ryuji
Аннотация
BACKGROUND: Opioid-induced constipation is a practical bowel-management issue when opioids are started for cancer pain, but real-world naldemedine timing and subsequent laxative needs remain variable.
OBJECTIVE: To describe naldemedine initiation timing/context after oxycodone start and early additional laxative adjustment among adults with cancer.
DESIGN: Single-center retrospective cohort study using routine clinical records.
SETTING/SUBJECTS: Adults with cancer pain in a single-center Japanese cancer-care setting who started oxycodone between June 1, 2017, and December 31, 2018, and subsequently received naldemedine.
MEASUREMENTS: Concurrent initiation was naldemedine prescribed as part of the same oxycodone-start prescribing decision; reactive initiation was naldemedine added as a separate prescribing decision after physician-recognized constipation during ongoing oxycodone therapy. The primary outcome was prescription-record-based additional laxative initiation or dose escalation of existing laxatives within 7 days after naldemedine initiation. Secondary outcomes were oxycodone-to-naldemedine interval and diarrhea-related discontinuation within 28 days.
RESULTS: Among 101 patients, the primary outcome occurred in 6/31 (19.4%) concurrent and 2/70 (2.9%) reactive cases (p = 0.010). The reactive group had a median oxycodone-to-naldemedine interval of 15 days (interquartile range, 5-83); diarrhea-related discontinuation occurred in 2/31 (6.5%) versus 6/70 (8.6%).
CONCLUSIONS: Concurrent naldemedine at oxycodone start did not eliminate early additional laxative initiation or escalation. Naldemedine timing should be understood within individualized bowel-management planning, with conventional or rescue laxatives considered when clinically appropriate.
OBJECTIVE: To describe naldemedine initiation timing/context after oxycodone start and early additional laxative adjustment among adults with cancer.
DESIGN: Single-center retrospective cohort study using routine clinical records.
SETTING/SUBJECTS: Adults with cancer pain in a single-center Japanese cancer-care setting who started oxycodone between June 1, 2017, and December 31, 2018, and subsequently received naldemedine.
MEASUREMENTS: Concurrent initiation was naldemedine prescribed as part of the same oxycodone-start prescribing decision; reactive initiation was naldemedine added as a separate prescribing decision after physician-recognized constipation during ongoing oxycodone therapy. The primary outcome was prescription-record-based additional laxative initiation or dose escalation of existing laxatives within 7 days after naldemedine initiation. Secondary outcomes were oxycodone-to-naldemedine interval and diarrhea-related discontinuation within 28 days.
RESULTS: Among 101 patients, the primary outcome occurred in 6/31 (19.4%) concurrent and 2/70 (2.9%) reactive cases (p = 0.010). The reactive group had a median oxycodone-to-naldemedine interval of 15 days (interquartile range, 5-83); diarrhea-related discontinuation occurred in 2/31 (6.5%) versus 6/70 (8.6%).
CONCLUSIONS: Concurrent naldemedine at oxycodone start did not eliminate early additional laxative initiation or escalation. Naldemedine timing should be understood within individualized bowel-management planning, with conventional or rescue laxatives considered when clinically appropriate.