Steroids

Steroids

PEP Topic 
Chronic Pain
Description 

Steroids are a type of compound that contains a characteristic chemical structure. Steroid drugs have anti-inflammatory activity. Systemic administration of steroids has been examined for its effect on arthralgia associated with treatment of cancer using aromatase inhibitors.

Effectiveness Not Established

Research Evidence Summaries

Kubo, M., Onishi, H., Kuroki, S., Okido, M., Shimada, K., Yokohata, K., . . . Katano, M. (2012). Short-term and low-dose prednisolone administration reduces aromatase inhibitor–induced arthralgia in patients with breast cancer. Anticancer Research, 32, 2331–2336.

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Study Purpose:

To determine whether short-term and low-dose prednisolone reduces aromatase inhibitor (AI)–induced arthralgias in patients with breast cancer

Intervention Characteristics/Basic Study Process:

Prednisolone 5 mg was administered to women once daily in the morning for one week.

Sample Characteristics:

  • The study reported on a sample of 27 patients.
  • Mean patient age was 62.8 years, with a range of 51–81 years.
  • All patients were hormone receptor–positive women with breast cancer.
  • Of the sample, 25 were taking anastrazole, and 2 were taking letrozole; 68% had finger pain, and 29% had knee joint pain.

Setting:

  • Multisite
  • Outpatient setting
  • Japan

Phase of Care and Clinical Applications:

Patients were undergoing active antitumor treatment.

Study Design:

The study was a prospective intervention clinical trial.

Measurement Instruments/Methods:

  • Questionnaire for assessment of arthralgia symptoms (no mention of validation); symptoms were measured at one week, one month, and two months.
  • A visual analog scale also was used to measure percentage of relief.

Results:

Joint symptoms improved in 67% of patients immediately after prednisolone, 63% continued to report relief at one month, and 52% at two months. Thirty percent of patients reported an improvement in daily life at one week and one month and 26% at two months.

Conclusions:

Results suggest that a low dose of 5 mg of prednisolone given for one week at the initiation of AI therapy can relieve arthralgias in some patients.

Limitations:

  • The study had a small sample, with less than 30 participants.     
  • The study had baseline sample/group differences of import (two patients on letrozole and others on anastrozole).     
  • The study had risk of bias due to no control group.
  • Measurement/methods were not well described.  
  • Measurement validity/reliability were questionable.
  • Adverse effects were not delineated.

Nursing Implications:

While this study suggests that AI-related pain can be reduced in patients with breast cancer using prednisolone, randomized controlled trials are needed that reflect longer follow-up and adverse event monitoring. Insufficient evidence exists to recommend practice implementation.

Systematic Review/Meta-Analysis

Paulsen, O., Aass, N., Kaasa, S., & Dale, O. (2013). Do corticosteroids provide analgesic effects in cancer patients? A systematic literature review. Journal of Pain and Symptom Management, 46, 96–105.

doi: 10.1016/j.jpainsymman.2012.06.019
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Purpose:

STUDY PURPOSE: To assess the evidence for use of corticosteroids as adjuvant analgesics in patients with cancer pain

TYPE OF STUDY: Systematic review

Search Strategy:

DATABASES USED: PubMed, EMBASE, Cochrane Collaboration, Cochrane Central Register of Controlled Trials

KEYWORDS: Specific search terms for PubMed are provided.

INCLUSION CRITERIA: RCT; adult patients with cancer; compared corticosteroids when added to standard pain treatment; assessed outcomes in pain, analgesic use, and adverse events

EXCLUSION CRITERIA: Non-English language

Literature Evaluated:

TOTAL REFERENCES RETRIEVED = 514

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Grading of Recommendations Assessment, Development and Evaluation; overall study quality in terms of risk of bias was low.

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = Four included, but only one study met all inclusion criteria
  • SAMPLE RANGE ACROSS STUDIES = 40–403
  • TOTAL PATIENTS INCLUDED IN REVIEW = 667
  • KEY SAMPLE CHARACTERISTICS: Primary cancers were gastrointestinal, breast, lung, and genitourinary. All patients were receiving palliative intervention.

Phase of Care and Clinical Applications:

  • PHASE OF CARE: End-of-life care
  • APPLICATIONS: Palliative care

Results:

Of the four studies included, one showed lower pain severity and analgesic consumption with steroid, two had unclear results because of lack of findings reported, and one showed no benefit.

Conclusions:

The evidence regarding efficacy of adjuvant corticosteroids for pain management in patients with cancer is insufficient to draw firm conclusions. No current evidence is strong enough to show efficacy, and information is limited about adverse events with any long-term use.

Limitations:

  • Very few studies
  • Most studies had low quality.
  • 50% of studies did not provide reporting of any adverse events.
  • Studies were short-term.
  • Despite limitations, authors suggest at least a weak recommendation for the use of corticosteroids.

Nursing Implications:

Evidence is insufficient to demonstrate benefit from the addition of corticosteroids to usual pain management in patients with cancer, and evidence is very limited regarding adverse effects in this setting. Studies only have been reported with short-term use, so long-term adverse effects are not clearly known.


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