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Table 2 Agreement achieved by the experts after the two rounds (Topic 2)

From: Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients

  Median
(IQR)
Agreement
(%)
Topic 2. Treatment of OIC
18. Prevention and early treatment (when symptoms are still mild) are recommended to anticipate the development of OIC. 9 (1) 97.87
19. Management of OIC becomes more complicated if treatment is started when OIC is already established and symptoms are more severe. 9 (1) 95.74
20. After scheduling an OIC treatment, frequent reassessment is recommended to optimize the treatment. 8 (1) 97.87
21. Effective OIC management involves maintaining OIC treatment while using opioid treatment. 9 (2) 91,48
22. For a better approach to OIC, it would be recommended to have simple questionnaires with criteria to assess the effectiveness of treatment for OIC. 9 (1) 93.62
23. For the treatment of OIC in oncological patients with polypharmacy, it is recommended to use drugs with comfortable administration. 9 (1) 97.87
24. Posology simplification of single daily dose oral treatments contributes to improve the patient’s satisfaction with the treatment. 9 (1) 97.87
25. High patient satisfaction with the prescribed treatment contributes to improving the efficacy of OIC treatment. 9 (1) 91.49
26. Good therapeutic adherence contributes to improving the efficacy of OIC treatment. 9 (1) 97.87
27. A good therapeutic strategy for OIC involves an individualization of the treatment, adapting it to the needs of each patient. 9 (1) 100.00
28. For a comprehensive approach it is necessary to treat both OIC and functional constipation, if both coexist. 8 (1) 91.49
29. Because of its pathophysiology, effective management of OIC requires a specific treatment that acts on the underlying cause. 8 (1) 95.75
30. Although hygienic-dietary recommendations are necessary for the treatment of OIC, they are not sufficiently effective. 8 (2) 91.48
31. Laxatives are often not effective for the treatment of OIC in cancer patients. 8 (2) 78.73
32. Oral PAMORA, such as naloxegol, are a good therapeutic alternatives in the treatment of OIC in cancer patients. 9 (1) 97.87
33. The use of enemas for the treatment of OIC in cancer patients should be used occasionally. 7 (2) 74.47
34. It is recommended to maintain the laxative dose when starting opioid treatment in cancer patients with functional constipation. 8 (2) 78.72
35. It is recommended to assess the efficacy of OIC treatment as soon as possible, especially during the first week after the start of treatment. 8 (2) 91.50
36. According to clinical practice, if the laxative has not met the therapeutic objectives for OIC treatment, it is recommended to take oral PAMORA (e.g. naloxegol, etc) while maintaining the dosage of the laxative as prescribed. 8 (2) 80.00
37. According to clinical practice in oncological patients with OIC, if the administration of oral PAMORA (e.g. naloxegol, etc.) in monotherapy has not fulfilled the therapeutic objective, the coexistence of other factors in the origin of constipation should be considered. 8 (2) 87.23
38. According to clinical practice in oncological patients with OIC, if the administration of oral PAMORA (e.g. naloxegol, etc.) in monotherapy has not fulfilled the therapeutic objective, adjuvant treatment with oral PAMORA and osmotic laxative should be recommended. 7 (2) 72.33
39. According to clinical practice in oncological patients with OIC and functional constipation, if adjuvant treatment with oral PAMORA and laxative has not met the therapeutic objective, occasional use of enemas may be considered. 8 (1) 78.72
40. According to clinical practice in oncological patients with OIC and functional constipation, if adjuvant treatment with oral PAMORA and laxative has not met the therapeutic objective, change between opioids may be considered. 8 (2) 72.34
41. Greater benefits are achieved from treatment with oral PAMORA (e.g. naloxegol, etc.) when started early. 8 (2) 93.62
42. If patients have severe symptoms of OIC with fecal impaction, it is recommended that a disimpaction be performed before starting treatment with oral PAMORA (e.g. naloxegol, etc.). 8 (1) 78.72
43. Poor OIC control can increase the number of medical visits. 9 (1) 93.62
44. Poor OIC control can increase the number of emergency visits. 9 (1) 91.49
45. Poor OIC control can lead to increased healthcare costs. 8 (1) 97.87
  1. IQR interquartile range, OIC opioid-induced constipation, PAMORA peripherally acting mu-opioid receptor antagonists