Team Identifies Top Constipation Risk Factors in GI Cancer

M. Alexander Otto, MMS, PA

March 24, 2022

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Patients with gastrointestinal cancer face a high risk for constipation, typically greater than with other cancers.

  • The researchers found diet and medication-related factors represented the primary risk factors for constipation in this patient population.

  • The Constipation Risk Assessment Scale (CRAS), a standard tool to assess constipation, can be revised to include risks specific to gastrointestinal cancer.

Why This Matters

  • Constipation is a significant cause of morbidity and distress in gastrointestinal cancer.  

  • Few studies have examined the risk factors associated with constipation.

  • Risk assessment and prevention should be routine after diagnosis to improve outcomes and quality of life.

Study Design

  • The team surveyed 190 patients in China with gastrointestinal cancer, using the Chinese version of the CRAS survey (CRAS-C).

  • Subjects were on average 59 years old, and the majority either had gastric or colorectal cancer.

  • A CRAS-C score of 11 points or higher was considered high-risk for constipation.

Key Results

  • The mean CRAS-C score was 13.2.

  • Overall, 139 patients (73.2%) scored 11 points or higher. 

  • The top 10 risk factors were insufficient liquid intake (81.1%), failure to consume bran products daily (78.9%), insufficient fiber intake (77.9%), antiemetics (74.7%), cytotoxic chemotherapy (52.6%), colorectal/abdominal diseases (42.6%), female sex (35.3%), opioid analgesics (26.8%), calcium channel blockers (16.3%), and endocrine disorders (14.2%).

  • Being constipated for the majority of the previous 3 months, ascites, and an ECOG Performance Status score of 1 or higher — factors not assessed by CRAS — were also associated with constipation.

  • In a previous study of 302 patients with multiple cancer types, 47% scored 11 points or higher.


  • Subjects were enrolled through a convenience sample, which might have biased the results.

  • Patients were surveyed once so changes in constipation risk factors over time were not assessed.


  • The Peking University Cancer Hospital's Science Foundation funded the work.

  • The investigators didn't report any relevant conflicts of interest.

This is a summary of a preprint research study, "Risk and Main Contributing Factors for Constipation in Patients with Gastrointestinal Cancer: A Multicenter Cross-Sectional Study in China," led by Xiaoxiao Ma of the Peking University Cancer Hospital & Institute. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email:

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