Maeda, T., & Hayakawa, T. (2017). Dyspnea-alleviating and survival-prolonging effects of corticosteroids in patients with terminal cancer. Progress in Palliative Care, 25, 117–120.

To evaluate the effectiveness of corticosteroid to improve dyspnea and prolong survival in patients with terminal cancer

Retrospective chart review of 52 patients with terminal cancer who received corticosteroid for dyspnea. Effectiveness of corticosteroid to reduce dyspnea was assessed using the Support Team Assessment Schedule (STAS-J) and patients were classified as responders (n = 30) and non-responders (n = 22) based on STAS-J scores. Survival was compared between the groups, with patient survival being the primary endpoint.

• N = 52   
• MEAN AGE: 70 years (total sample)
• MALES: 57.7%  
• FEMALES: 42.3%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Terminal phase of cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Dyspnea from pleural effusion, lymphangitis carcinomatosis, and lung metastasis

• SITE: Not stated/unknown   
• SETTING TYPE: Not specified    
• LOCATION: Municipal hospital in Japan

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

Retrospective chart review of terminal patients who received either oral or IV corticosteroids. Patients were classified as responders or non-responders and survival was compared between the groups.

Effectiveness of corticosteroids to alleviate dyspnea was assessed using the Support Team Assessment Schedule (STAS-J) dividing patients into responders and non-responders. The Mann-Whitney U test compared survival between responders and non-responders, the chi-square test analyzed patient background information, and the Common Terminology Criteria for Adverse Events (CTCAE), version 4, evaluated adverse effects.

There was significant improvement in survival for patients who responded to corticosteroids with reduced dyspnea then those that did not using the Mann-Whitney U test (8.5 versus 5 days, p = 0.0019). Side effects observed with corticosteroids included insomnia (15.4%), delirium (11.5%), and hyperglycemia (3.8%).

The use of corticosteroid alone or in combination with opioid did reduce dyspnea in some patients at end of life and, therefore, resulted in prolonged survival. However, side effects of corticosteroids must be taken into consideration when assessing reduced dyspnea and evaluating the benefit of prolonged survival.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Other limitations/explanation: Retrospective study, lacks power to detect in depth statistical differences, no effective dose of corticosteroid established.

Dyspnea occurs at end of life and can be difficult to manage. Therapies to effectively reduce dyspnea at end of life are needed. Corticosteroid therapy may alleviate dyspnea in some patients at end of life. Nurses must continue to assess effectiveness of corticosteroids to reduce dyspnea along with side effects that may occur from therapy.