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Comprehensive Cancer Pain Management: Let's Talk Constipation

Comprehensive Cancer Pain Management: Let's Talk Constipation



Time to Complete

1 hour


July 12, 2019


July 12, 2020
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Maximum Credits

1.00 / AMA PRA Category 1 CreditTM
1.00 / CNE Contact Hours

Accredited Provider

This activity is jointly provided by Global Education Group and Integritas Communications.

Commercial Supporter

This activity is supported by an educational grant from AstraZeneca.

Program Description/Statement of Need

Despite the growing number of options to treat constipation symptoms, many patients with cancer pain suffer the burden of OIC.1,2 Patients are often reluctant to discuss symptoms of constipation, underscoring the need for clinicians to provide ongoing education on the signs and symptoms of OIC as well as the need to monitor bowel patterns at each visit.3,4 A collaborative, team-based approach that utilizes shared decision-making to address patients’ unique preferences regarding OIC treatment is another critical aspect of care.5,6

During this Collaborative Care™ activity, a multidisciplinary panel of expert faculty will review and discuss individualized management plans for OIC in patients with cancer pain. Patient simulation videos will help guide attendees through proper OIC assessment with validated clinical tools, initiation and escalation of appropriate therapies with respect to updated evidence-based guidelines, and effective patient communication strategies for discussing opioid-related bowel issues and available treatment options.

1. Rumman A, Gallinger ZR, Liu LWC. Opioid induced constipation in cancer patients: pathophysiology, diagnosis and treatment. Expert Rev Qual Life Cancer Care. 2016; 1(1):25-35.
2. Gatti A, Sabato AF. Management of opioid-induced constipation in cancer patients: focus on methylnaltrexone. Clin Drug Investig. 2012;32(5):293-301.
3. Coyne KS, LoCasale RJ, Datto CJ, Sexton CC, Yeomans K, Tack J. 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. 2014;6:269-281.
4. Coyne KS, Margolis MK, Yeomans K, et al. 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. 2015;16(8):1551-1565.
5. Murray E, Charles C, Gafni A. Shared decision-making in primary care: tailoring the Charles et al. model to fit the context of general practice. Patient Educ Couns. 2006;62(2):205-211.
6. Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77(4):219-226.

Intended Audience

The educational design of this activity addresses the needs of oncology nurses, medical oncologists, and other clinicians involved in the treatment of patients with opioid-induced constipation (OIC).

Educational Objectives

Upon completion of this activity, participants will be better able to do the following:

  • Evaluate baseline and ongoing bowel patterns in patients with opioid-treated cancer pain
  • Discuss the clinical profiles and guideline recommendations for US Food and Drug Administration (FDA)-approved treatment options for opioid-induced constipation (OIC)
  • Recommend bowel regimens for patients with opioid-treated cancer pain who do not respond to traditional laxative therapy
  • Engage with patients with opioid-treated cancer pain to facilitate bowel assessment effort and shared decision-making about OIC therapies

Conflict Of Interest Disclosure Policy

Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:


Mihir M. Kamdar, MD
Associate Director, Division of Palliative Care
Director, Cancer Pain Clinic
Attending, Palliative Care and Anesthesia Pain Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts

Dr. Kamdar has nothing to disclose.

Kathleen Madden, FNP, MSN, AOCNP, APHN
Nurse Practitioner, Melanoma Program
New York University Health
NYU Langone Perlmutter Cancer Center
New York, New York

Ms. Madden has nothing to disclose.

Bill H. McCarberg, MD
Adjunct Assistant Clinical Professor
University of California, San Diego School of Medicine
San Diego, California

Dr. McCarberg discloses the following:
Consultant: Averitas Pharma, Inc., Pfizer Inc., Scilex Pharmaceuticals, Inc.;
Speakers Bureau: Adapt Pharma, Inc.;
Stock Shareholder: Biospecifics Technologies Corp., Collegium Pharmaceuticals, Inc., Johnson & Johnson Services, Inc., Sellas Life Sciences Group, Inc.

Planners' and Managers' Disclosures

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME/CE activity:

Lindsay Borvansky has nothing to disclose.
Andrea Funk has nothing to disclose.
Ashley Cann has nothing to disclose.
Ashley Marostica, RN, MSN, has nothing to disclose.
Jim Kappler, PhD, has nothing to disclose.
Celeste Collazo, MD, has nothing to disclose.




AMA PRA Category 1 Credit(s)TM

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Integritas Communications. Global is accredited by the ACCME to provide continuing medical education for physicians.

Designation Statement

Global Education Group designates this enduring activity for a maximum of 1.00 AMA PRA Category 1 CreditTM  .  Physicians should claim only the credit commensurate with the extent of their participation in the activity.




CNE Contact Hour(s)

Accreditation Statement

Global Education Group is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Designation Statement

This educational activity for 1.00 contact hours is provided by Global Education Group. Nurses should claim only the credit commensurate with the extent of their participation in the activity. Disclosure of Conflicts of Interest

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Fee and Refund / Cancellation Policy

There is no fee for this educational activity.


In order to receive credit, participants must complete the pre-assessment questions, view the activity in its entirety, and complete the post-test, and program evaluation. Participants must also score at least 80% on the post-test. You will receive a digital copy of your credit certificate at the conclusion of the activity. Your online certificate will be saved on myCME within your Profile/Exam History, which you can access at any time.

For information about the accreditation of this program, please contact Global at 303-395-1782 or

If you have any other questions relating to your certificate or other issues with the activity, please contact

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Hardware and Software Requirements
  • A computer with an internet connection
  • Internet Browser: Internet Explorer 7.x or higher, Firefox 4.x or higher, Safari 2.x or higher, or any other W3C standards compliant browser
  • Additional Software: Adobe Flash Player and/or an HTML 5 capable browser maybe required for video or audio playback. PowerPoint or Adobe Acrobat Reader may occasionally be required
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