Differences in Adverse Effect Profiles of Corticosteroids in Palliative Care Patients

Jaward, Leanna R; O'Neil, Thomas A.; Marks, Adam; Smith, Michael A.

doi:10.1177/1049909118797283

Cited by 10 publications

(10 citation statements)

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“…Evidence for their efficacy is weak, although a Cochrane systematic review found that some studies showed a beneficial effect on cancerrelated pain after 1 week of treatment. 83 In light of the many well-documented adverse effects, 84 the likely benefit to risk ratio for the individual needs careful consideration.…”

Section: 'Don't Know'mentioning

confidence: 99%

Practice review: Evidence-based and effective management of pain in patients with advanced cancer

et al. 2020

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Background: Pain of a moderate or severe intensity affects over half of patients with advanced cancer and remains undertreated in at least one-third of these patients. Aim: The aim of this study was to provide a pragmatic overview of the evidence supporting the use of interventions in pain management in advanced cancer and to identify where encouraging preliminary results are demonstrated but further research is required. Design: A scoping review approach was used to examine the evidence supporting the use of guideline-recommended interventions in pain management practice. Data sources: National or international guidelines were selected if they described pain management in adult cancer patients and were written within the last 5 years in English. The Cochrane Database of Systematic Reviews (January 2014 to January 2019) was searched for ‘cancer’ AND ‘pain’ in the title, abstract or keywords. A MEDLINE search was also made. Results: A strong opioid remains the drug of choice for treating moderate or severe pain. Bisphosphonates and radiotherapy are also effective for cancer-related bone pain. Optimal management requires a tailored approach, support for self-management and review of treatment outcomes. There is likely a role for non-pharmacological approaches. Paracetamol should not be used in patients taking a strong opioid to treat pain. Cannabis-based medicines are not recommended. Weak opioids, ketamine and lidocaine are indicated in specific situations only. Conclusion: Interventions commonly recommended by guidelines are not always supported by a robust evidence base. Research is required to evaluate the efficacy of non-steroidal anti-inflammatory drugs, anti-convulsants, anti-depressants, corticosteroids, some invasive anaesthetic techniques, complementary therapies and transcutaneous electrical nerve stimulation.

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Section: 'Don't Know'mentioning

confidence: 99%

Practice review: Evidence-based and effective management of pain in patients with advanced cancer

et al. 2020

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“…In clinical practice, corticosteroids are widely used in cancer patients in the palliative phase to alleviate inflammatory pain, relieve nausea, reduce peritumoral oedema, increase appetite, reduce itching and to reduce fatigue [72,73]. As shown above, clinical trials investigating the effect of corticosteroids on fatigue in patients with advanced or metastatic cancer are scarce and partly based on observational studies [74,75].…”

Section: Corticosteroidsmentioning

confidence: 99%

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

Klasson

Frankling

Hagelin

et al. 2021

Cancers

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Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large meta-analysis of interventions on fatigue focuses mostly on patients early in the disease trajectory, with only one tenth of included studies performed in palliative cohorts. The aim of this narrative review is therefore to present a background on CRF with focus on the palliative setting. A summary of recent randomized, controlled trials on pharmacological interventions on CRF in palliative care is presented, including studies on psychostimulants, corticosteroids, testosterone and melatonin. Interestingly, in several of these studies there was a positive and similar effect on fatigue in both the intervention and the placebo arm—indicating an important placebo effect for any pharmacological treatment. In addition, studies on dietary supplements and on pharmacological complementary medicines are discussed. To conclude, the evidence is still weak for using pharmacological treatments on CRF in palliative care patients—although methylphenidate and corticosteroids might be considered.

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“…Prices from goodrx.com . Information from Allen et al, 2016 ; Collis & Mather, 2015 ; Digges et al, 2018 ; Harder et al, 2019b ; Hendren et al, 2015 ; Hernandez et al, 2015 ; Jaward et al, 2019 ; Kaneishi et al, 2016 ; Khanna et al, 2019 ; Khoo & Quinlan, 2016 ; Langley-DeGroot et al, 2015 ; Lovell et al, 2018 ; MacKintosh, 2016 ; Prohotsky et al, 2014 ; Prommer, 2012 ; Riordan et al, 2019 ; van der Meer et al, 2014 ; Wiebe, 2012 . …”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benunclassified

“…Corticosteroids are inexpensive and useful for N/V related to primary or metastatic brain tumors, MBO, or with unexplained N/V ( Collis & Mather, 2015 ; Glare et al, 2011 ; Hendren et al, 2015 ). The duration of action of dexamethasone is 36 to 72 hours; prednisone and methylprednisolone act for 12 to 36 hours ( Jaward, O’Neil, Marks, & Smith, 2019 ). Dexamethasone is the most potent anti-inflammatory: dexamethasone at 0.75 mg ≈ prednisone at 5 mg ≈ methylprednisolone at 4 mg.…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

“…Typical dexamethasone “antiemetic” doses are 4 to 8 mg once daily, and ≤ 16 mg daily for MBO or increased intracranial pressure ( Glare et al, 2011 ). The lowest effective steroid dose should be used for the shortest time, such as 7 to 10 days for patients with MBO ( Collis & Mather, 2015 ; Jaward et al, 2019 ). Higher doses for longer periods increase risks for adverse events in many body systems.…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

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Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

Wickham¹

2020

JADPRO

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Purpose Unlike therapy-related nausea and vomiting (chemotherapy or radiotherapy induced), nausea and vomiting (N/V) in patients with advanced cancer is often multicausal and thus presents unique challenges. Few professional guidelines address the palliative management of N/V, and those that do are insufficiently detailed to bolster clinical decision-making. Nonetheless, oncology advanced practitioners (APs) are frequently challenged to manage these high-impact symptoms. This requires collaborating with other oncology care providers and cultivating a knowledge base to educate and mentor professional colleagues to optimize N/V unrelated to treatment. Methods Literature reviewed included current and classic articles that address the physiologic bases of N/V related to disease and with malignant bowel obstruction, agents used to alleviate nausea or N/V, and nonpharmacologic adjunctive measures. This information was framed within palliative care and symptom management clinical experience. Results This review article summarizes what is known about the neuropharmacology of N/V in advanced disease. Focused assessment, pharmacologic agents (antiemetics, central neuromodulators, and peripheral prokinetic agents), and nondrug adjunctive measures that may be useful for N/V are included. Conclusions Managing N/V in advanced cancer is a quality-of-life imperative that requires persistence and interprofessional collaboration among oncology APs and other clinicians to personalize management. This work can change the perception that N/V related to progressive disease is frequently intractable to one that considers it as a manageable clinical challenge.

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Differences in Adverse Effect Profiles of Corticosteroids in Palliative Care Patients

Abstract: Recognition of corticosteroid induced adverse effect profiles and possible management strategies is crucial to optimal symptom management in palliative care patients.

Cited by 10 publications

References 28 publications

Practice review: Evidence-based and effective management of pain in patients with advanced cancer

Practice review: Evidence-based and effective management of pain in patients with advanced cancer

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

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