Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Dinesh S. Pashankar

Second Advisor

Farzana D. Pashankar

Subject Area(s)

Oncology, Medicine

Abstract

ACUTE CONSTIPATION IN CHILDREN RECEIVING CHEMOTHERAPY FOR CANCER.

J. Hale Season, Farzana D. Pashankar, Joseph McNamara, and Dinesh S. Pashankar. Sections of Pediatric Gastroenterology and Pediatric Hematology-Oncology, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

We hypothesized that the prevalence of constipation amongst children on chemotherapy would be high, and that certain pharmacologic interventions commonly used in this population (especially vinca alkaloids, narcotic analgesics, and ondansetron) would be associated with constipation. We also hypothesized that constipation would be perceived as an important problem with a significant impact on lifestyle. We prospectively studied 61 children receiving chemotherapy for cancer by administering questionnaires to patients and their parents. We obtained demographics, bowel movement history, interventions for constipation, chemotherapy agents, other medications, perception of constipation as a problem, and impact on lifestyle. 35 of 61 (57% ± 12%) children were found to meet NASPGHAN criteria for constipation during chemotherapy, while 46 of 61 (77% ± 11%) were found to have signs and symptoms suggestive of constipation and 42 of 61 (69% ± 12%) required the use of laxatives while on chemotherapy. Among children with NASPGHAN criteria constipation, 15 of 35 (43% ± 16%) perceived it as a major/significant problem and 8 of 35 (23% ± 14%) noted a major/significant impact on lifestyle. We concluded that criteria for acute constipation were found in 57% of children receiving chemotherapy for cancer, though less stringent criteria suggest a prevalence of up to 77%. Even though this study lacked sufficient power for most associations, combined use of vincristine and opiates was associated with constipation (p<0.03). Constipation was found to have a high prevalence in children on chemotherapy, and it is perceived as a significant problem by patients and their parents with an adverse effect on lifestyle.

Comments

This is an Open Access Thesis.

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