Corticosteroids are a class of steroid hormones produced in the adrenal cortex. They are involved in a wide range of physiologic systems such as the stress and immune responses, the regulation of inflammation, carbohydrate metabolism, and protein catabolism. Corticosteroids can be administered orally, intravenously, or topically and are used to treat a variety of conditions. Drugs in this class include dexamethasone, methylprednisone, prednisone, hydrocortisone, mometasone, betamethasone, and fludrocortisones. Systemic corticosteroids have been examined in for their efficacy in the management of anorexia and pain, and specific, individual corticosteroids typically are part of drug regimens to treat chemotherapy-induced nausea and vomiting. The systemic administration of corticosteroids has been examined for effects on arthralgia associated with cancer treatment using aromatase inhibitors because of the anti-inflammatory property of steroids.
Begley, S., Rose, K., & O'Connor, M. (2016). The use of corticosteroids in reducing cancer-related fatigue: Assessing the evidence for clinical practice. International Journal of Palliative Nursing, 22, 5–9.
STUDY PURPOSE: To assess the evidence regarding the use of corticosteroids for fatigue among patients with advanced cancer
SAMPLE RANGE ACROSS STUDIES,
All studies reported improvement in patient-reported fatigue. Gaps were noted in information regarding side effects and the specifics of the dosage, etc., of the intervention.
Corticosteroids may improve fatigue in patients with advanced cancer, but potential adverse side effects have not been examined well.
Corticosteroids may improve fatigue in patients with cancer, but insufficient information about adverse effects exists. Steriods should not be used for a long duration—an intervention that may be useful for patients who desire short-term improvement in feelings of fatigue to participate in family events, etc.
Paulsen, O., Klepstad, P., Rosland, J.H., Aass, N., Albert, E., Fayers, P., & Kaasa, S. (2014). Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: A randomized, placebo-controlled, double-blind trial. Journal of Clinical Oncology. Advance online publication.
To compare the analgesic efficacy of corticosteroid therapy versus a placebo
The intervention was methylprednisolone 32 mg daily for seven days. The research team used a computerized randomization program to assign participants to intervention or placebo groups. Randomization stratification was based on study center and verified pain related to bone metastases. Both the research team and study participants were blinded to study assignment. Pain intensity, fatigue, and appetite loss were measured at baseline and day 7. Analgesic use was recorded daily. Satisfaction with the intervention was measured at day 7. Semistructured interviews were conducted at day 7 to determine any adverse effects experienced by study participants.
Placebo-controlled, double-blind, randomized controlled trial
No significant difference was found between groups for average pain intensity at day 7, change in pain intensity from baseline, opioid intake, or adverse events. However, the intervention group did have a significant improvement in fatigue (p = .003) and appetite (p = .003) at day 7 compared to the placebo group. In addition, their overall satisfaction with treatment was also significantly greater (p = .001).
Pain relief was not improved for patients with advanced cancer who were taking on average a 222 mg oral morphine equivalent dose (MED). It is unknown whether this may be effective for different patient populations such as those taking a lower MED. Improvement in fatigue and appetite and a low number of adverse events were important clinical outcomes. Further study is needed to determine the long-term effects of this intervention.
Nurses should be aware that methylprednisolone 32 mg daily may not be effective for improving pain relief in patients with advanced cancer who are taking an average opioid dose of ≥ 220 MED; however, it may improve fatigue and appetite with minimal adverse effects. Long-term effects have not yet been established. Long-term steroid use can contribute to other adverse side effects and should be weighed carefully with benefit of treatment.
Yennurajalingam, S., Frisbee-Hume, S., Palmer, J.L., Delgado-Guay, M.O., Bull, J., Phan, A.T., . . . Bruera, E. (2013). Reduction of cancer-related fatigue with dexamethasone: A double-blind, randomized, placebo-controlled trial in patients with advanced cancer. Journal of Clinical Oncology, 31, 3076–3082.
Compare the effect of dexamethasone and placebo on cancer-related fatigue (CRF) and quality of life.
Dexamethasone 4 mg or placebo orally twice a day for 14 days.
Dexamethasone and placebo groups had no differences in patient characteristics at baseline with the exception of more females in the dexamethasone group. Mean improvement scores of the FACIT-F subscale scores and ESAS physical distress scores were significantly better in the dexamethasone than the placebo group at days 8 (p = .005) and 15 (p = .008). ESAS pain was significantly better in the dexamethasone group on day 8. FAACT subscale scores were significantly better in the dexamethasone group on day 15. Fatigue did decline in both study groups. All other variables showed no significant differences in scores or frequency of adverse events.
Dexamethasone is more effective than placebo in improving CRF and quality of life in patients with advanced cancer.
A need exists for larger, long-term studies to determine safety and efficacy in patients with cancer (palliative care and active treatment). A significant number of patients with advanced cancer present with multiple signs and symptoms that may or may not benefit from dexamethasone therapy. Clinicians should be aware of barriers to adherence with dexamethasone.