Haywood, A., Good, P., Khan, S., Leupp, A., Jenkins-Marsh, S., Rickett, K., & Hardy, J.R. (2015). Corticosteroids for the management of cancer-related pain in adults. Cochrane Database of Systematic Reviews, 4, CD010756. 

DOI Link

Purpose

STUDY PURPOSE: To assess whether corticosteroids were effective in the reduction of cancer-related pain
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, EMBASE, CINAHL, and Web of Science
 
KEYWORDS: Adrenal Cortex Hormones, corticoid* or corticosteroid* or glucocorticoid*, betamethasone, fludrocortisone/ fludrocortisone, cortisone/cortisone acetate or cortisone deflazacort, dexamethasone, hydrocortisone, methylprednisolone, prednisolone, triamcinolone, pain, pain Measurement, analgesics, analgesia, analges*, quality of life, malignant, malignancy, tumor*, tumor*, cancer*, carcinoma*, Neoplasms,  randomized controlled trial,  controlled clinical trial, randomized, randomized, placebo, drug therapy, randomly, trial, groups, exp animals/ not humans.
 
INCLUSION CRITERIA: Randomized, controlled trials or prospective, controlled trials; participants aged 18 years or greater with cancer-related pain; all routes considered for drug administration; interventions included nonpharmacologic, usual or supportive care, placebo, or no intervention
 
EXCLUSION CRITERIA: No language, date, or publication status was applied to the search. Date range was 1899–2014.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 5,891 (743 duplicates and 5,107 excluded by abstract or title)
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Cochrane handbook was used for the study evaluation.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 15 (There was a meta-analysis of six studies.)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,926
  • SAMPLE RANGE ACROSS STUDIES: 20–598 patients
  • KEY SAMPLE CHARACTERISTICS: Small sample sizes

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Palliative care

Results

Studies included were of steroids used as a treatment with pain assessed as an outcome. Dexamethasone was used in eight studies. Nine of the studies were designed with pain as an outcome. Six were placebo-controlled studies, one was a crossover study with a placebo, five had active controls, one was an open-label study, and two were low- versus high-dose studies. There did not appear to be a statistic benefit to the use of corticosteroids for all patients with cancer-related pain. Studies compared corticosteroids to standard therapy. A meta-analysis was done of six studies, and the others were not included because of missing data. There was insufficient data to do a subgroup analysis. A data point of one week was used as a standardization point for the interventions of the six studies in the meta-analysis. The meta-analysis showed an overall mean difference of –0.84 (p = 0.002) in favor of corticosteroids. There was insufficient evidence to evaluate side effects.

Conclusions

Evidence appeared to be weak in regard to the efficacy of corticosteroids for pain relief in patients with cancer. Although the meta-analysis suggested some benefit, the confidence interval was wide, and the quality of the studies included was low.

Limitations

  • Ability to assess effectiveness limited by small sample size
  • High risk of bias
  • Low quality of evidence

Nursing Implications

There was limited evidence to support the use of corticosteroids for chronic pain. If used, their benefit should be evaluated frequently and discontinued if none is found. Corticosteroids have numerous side effects, and the benefits versus harms must be weighed before their use in patients with cancer-related pain.

Legacy ID

5551