ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation

Oncol Nurs Forum. 2020 Nov 1;47(6):671-691. doi: 10.1188/20.ONF.671-691.


Purpose: This evidence-based guideline intends to support clinicians, patients, and others in decisions regarding the treatment of constipation in patients with cancer.

Methodologic approach: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of cancer-related constipation. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the evidence and make recommendations.

Findings: The panel agreed on 13 recommendations for the management of opioid-induced and non-opioid-related constipation in patients with cancer.

Implications for nursing: The panel conditionally recommended a bowel regimen in addition to lifestyle education as first-line treatment for constipation. For patients starting opioids, the panel suggests a bowel regimen as prophylaxis. Pharmaceutical interventions are available and recommended if a bowel regimen has failed. Acupuncture and electroacupuncture for non-opioid-related constipation are recommended in the context of a clinical trial.

Supplementary material can be found at https: //bit.ly/30y29sI.

Keywords: GRADE; acupuncture; cancer; constipation; guideline; opioid-induced constipation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid* / adverse effects
  • Constipation / chemically induced
  • Constipation / drug therapy
  • Humans
  • Neoplasms* / complications
  • Neoplasms* / drug therapy


  • Analgesics, Opioid