Antitumoral Agent-Induced Constipation: A Systematic Review

Simple Summary Constipation is the third most common symptom in patients receiving cytotoxic chemotherapy, and it can impact their quality of life. There is no clear definition of constipation. Several factors may cause constipation in cancer patients, such as the direct effect of the tumor, comorbidities, polypharmacy, or antitumoral treatments. Being aware of its prevalence is crucial for all physicians and nurses who treat those patients to more precisely address the symptoms. A total of 22.07% of patients present constipation when they are under antitumoral treatments. The loss of enteric neurons following the administration of antitumoral treatments may cause constipation, but the etiology is not completely established. It is difficult to recommend specific treatments for antitumoral treatment-induced constipation without more knowledge of the specific cause. Narratives and scoping reviews recommend using laxatives as a treatment. Other studies show the benefits of acupuncture, moxibustion, osteopaths, and probiotics. In many countries, acupuncture and moxibustion are not available in the public system, and most healthcare professionals are not familiar with those methods. Thus, although laxatives may be used, more specific studies on the prevalence and etiology of and specific treatments for antitumoral treatment-induced constipation are needed.Abstract Background: Constipation is a common symptom in patients receiving antitumoral treatment. The mechanisms underlying antitumoral agent-induced constipation (ATAIC) are poorly defined. This systematic review aimed to analyze and synthesize the available information related to the prevalence, etiology, and treatment of ATAIC. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. The review included human studies written in English, French, or Spanish involving patients with cancer and containing information about the prevalence, etiology, and treatment of ATAIC. Results: A total of 73 articles were included. The reported prevalence ranged from 0.8% to 86.6%. Six studies reported an ATAIC prevalence of over 50%. The prevalence rates of constipation of grades 3 and 4 ranged between 0 and 11%. The importance of enteric neuronal integrity in gastrointestinal function was reported. The articles with the highest levels of evidence in relation to ATAIC treatment obtained in this systematic review studied treatments with acupuncture, sweet potato, osteopath, probiotics, and moxibustion. Conclusions: The prevalence of constipation in patients undergoing antitumoral treatment is very diverse. Studies specifically designed to report the prevalence of antineoplastic treatment-induced constipation are needed. The importance of enteric neuronal integrity in gastrointestinal function was described. Thus, neuroprotection could be an area of research for the treatment of chemotherapy-induced gastrointestinal disorders.