Supportive Care in Cancer

, Volume 27, Issue 2, pp 687–696 | Cite as

Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy

  • Perry G. FineEmail author
  • Yen-Wen Chen
  • Eric Wittbrodt
  • Catherine Datto
Original Article



Opioid therapy is often associated with adverse effects, including opioid-induced constipation (OIC), in patients receiving opioids for cancer pain. This retrospective observational cohort study evaluated healthcare utilization and costs during the first year after initiating opioid therapy among cancer patients with (cohort 1) and without (cohort 2) constipation.


This study used administrative claims data from the HealthCore Integrated Research Environment between January 1, 2006, and April 30, 2014. Eligible patients included adults ≥ 18 years with a diagnosis of cancer who initiated continuous opioid therapy (≥ 30 days). Propensity scores were used to match patients with constipation in a 1:1 ratio to those without constipation. Generalized linear models were used to evaluate healthcare utilization and costs during the 12 months after initiating opioid therapy.


After matching, 1369 patients were included in each cohort. Patients with constipation were more than twice as likely as those without constipation to have an all-cause inpatient hospitalization (odds ratio [95% confidence interval (CI)], 2.47 [2.11–2.90]), or pain-related hospitalization (2.15 [1.82–2.54]) during the 12 months after initiating therapy. Mean unadjusted overall healthcare costs during the first 12 months post-index were $21,629 (95% CI, $14,850–$29,018) higher for patients with constipation than for those without constipation. For patients with constipation, total mean (SD) constipation-related costs were $9196 ($26,896).


These results suggest that OIC is associated with significantly increased healthcare and economic burden in cancer pain patients and that early and ongoing recognition and management of OIC are unmet needs in this population.


Opioid-induced constipation Cancer pain Healthcare utilization Costs 



The authors thank Megan Knagge, PhD, of MedErgy (Yardley, PA, USA) for providing medical writing support, which was in accordance with Good Publication Practice (GPP3) guidelines and funded by AstraZeneca (Wilmington, DE, USA).

Funding information

This study was supported by AstraZeneca Pharmaceuticals, LP (Wilmington, DE).

Compliance with ethical standards

For this retrospective study based on administrative data, formal consent was not required. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki.

Conflict of interest

P.G.F. is on the Board of Directors of Magellan Health, and he has received consulting fees from AstraZeneca Pharmaceuticals, Capital Caring, and Endo Pharmaceuticals within the last 36 months. Y.-W.C. is an employee of HealthCore, Inc. E.W. and C.D. are employees of AstraZeneca.

Supplementary material

520_2018_4366_MOESM1_ESM.docx (201 kb)
ESM 1 (DOCX 201 kb)


  1. 1.
    van den Beuken-van Everdingen MHJ, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ (2016) Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag 51:1070–1090Google Scholar
  2. 2.
    Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433CrossRefGoogle Scholar
  3. 3.
    Portenoy RK (2011) Treatment of cancer pain. Lancet 377:2236–2247CrossRefGoogle Scholar
  4. 4.
    World Health Organization (1996) Cancer pain relief: with a guide to opioid availability, 2nd edition. World Health Organization, GenevaGoogle Scholar
  5. 5.
    Wiffen PJ, McQuay HJ (2007) Oral morphine for cancer pain. Cochrane Database Syst Rev CD003868Google Scholar
  6. 6.
    Gregorian RS Jr, Gasik A, Kwong WJ, Voeller S, Kavanagh S (2010) Importance of side effects in opioid treatment: a trade-off analysis with patients and physicians. J Pain 11:1095–1108CrossRefGoogle Scholar
  7. 7.
    Abramowitz L, Beziaud N, Labreze L, Giardina V, Causse C, Chuberre B, Allaert FA, Perrot S (2013) Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: DYONISOS study. J Med Econ 16:1423–1433CrossRefGoogle Scholar
  8. 8.
    Coyne KS, Sexton C, LoCasale RJ, King FR, Margolis MK, Ahmedzai SH (2016) Opioid-induced constipation among a convenience sample of patients with cancer pain. Front Oncol 6:131CrossRefGoogle Scholar
  9. 9.
    Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, de Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G (2012) Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol 13:e58–e68CrossRefGoogle Scholar
  10. 10.
    Droney J, Ross J, Gretton S, Welsh K, Sato H, Riley J (2008) Constipation in cancer patients on morphine. Support Care Cancer 16:453–459CrossRefGoogle Scholar
  11. 11.
    Mancini I, Bruera E (1998) Constipation in advanced cancer patients. Support Care Cancer 6:356–364CrossRefGoogle Scholar
  12. 12.
    National Center for Health Statistics (2005) International classification of diseases, 9th revision, clinical modification (ICD-9-CM). Accessed 22 March 2018
  13. 13.
    Austin PC (2008) A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med 27:2037–2049CrossRefGoogle Scholar
  14. 14.
    Parsons LS (2011) Reducing bias in a propensity score matched-pair sample using greedy matching techniques. SAS SUGI 26:214–226Google Scholar
  15. 15.
    Austin PC (2010) Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol 172:1092–1097CrossRefGoogle Scholar
  16. 16.
    National Comprehensive Cancer Network (2017) NCCN clinical practice guidelines in oncology (NCCN guidelines®). Adult cancer pain version 22017 May 10, 2017. Accessed 22 March 2018
  17. 17.
    Candrilli SD, Davis KL, Iyer S (2009) Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy. J Pain Palliat Care Pharmacother 23:231–241CrossRefGoogle Scholar
  18. 18.
    Coyne KS, Margolis MK, Yeomans K, King FR, Chavoshi S, Payne KA, LoCasale RJ (2015) Opioid-induced constipation among patients with chronic noncancer pain in the United States, Canada, Germany, and the United Kingdom: laxative use, response, and symptom burden over time. Pain Med 16:1551–1565CrossRefGoogle Scholar
  19. 19.
    Coyne KS, LoCasale RJ, Datto CJ, Sexton CC, Yeomans K, Tack J (2014) Opioid-induced constipation in patients with chronic noncancer pain in the USA, Canada, Germany, and the UK: descriptive analysis of baseline patient-reported outcomes and retrospective chart review. Clinicoecon Outcomes Res 6:269–281CrossRefGoogle Scholar
  20. 20.
    Wan Y, Corman S, Gao X, Liu S, Patel H, Mody R (2015) Economic burden of opioid-induced constipation among long-term opioid users with noncancer pain. Am Health Drug Benefits 8:93–102PubMedPubMedCentralGoogle Scholar
  21. 21.
    Lawson R, Marsh K, Altincatal A, King F (2014) How does non-malignant opioid induced constipation (OIC) impact health state utility? Value Health 17:A369CrossRefGoogle Scholar
  22. 22.
    Fernandes AW, Kern DM, Datto C, Chen YW, McLeskey C, Tunceli O (2016) Increased burden of healthcare utilization and cost associated with opioid-related constipation among patients with noncancer pain. Am Health Drug Benefits 9:160–170PubMedPubMedCentralGoogle Scholar
  23. 23.
    Alemayehu B, Coyne KS, King F (2014) Self reported health care resource use and indirect economic burden of opioid induced constipation (OIC). Value Health 17:A541CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Perry G. Fine
    • 1
    Email author
  • Yen-Wen Chen
    • 2
  • Eric Wittbrodt
    • 3
  • Catherine Datto
    • 3
  1. 1.School of MedicineUniversity of Utah Pain Research and Management CentersSalt Lake CityUSA
  2. 2.HealthCore, Inc.WilmingtonUSA
  3. 3.US Medical AffairsAstraZenecaWilmingtonUSA

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