Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

Abstract

Objective. Advanced cancer patients frequently experience debilitating symptoms that occur in clusters, but few pharmacological studies have targeted symptom clusters. Our objective was to examine the effects of dexamethasone on symptom clusters in patients with advanced cancer. Methods. We reviewed the data from a previous randomized clinical trial to determine the effects of dexamethasone on cancer symptoms. Symptom clusters were identified according to baseline symptoms by using principal component analysis. Correlations and change in the severity of symptom clusters were analyzed after study treatment. Results. A total of 114 participants were included in this study. Three clusters were identified: fatigue/anorexia-cachexia/ depression (FAD), sleep/anxiety/drowsiness (SAD), and pain/dyspnea (PD). Changes in severity of FAD and PD significantly correlated over time (at baseline, day 8, and day 15). The FAD cluster was associated with significant improvement in severity at day 8 and day 15, whereas no significant change was observed with the SAD cluster or PD cluster after dexamethasone treatment. Conclusion. The results of this preliminary study suggest significant correlation over time and improvement in the FAD cluster at day 8 and day 15 after treatment with dexamethasone. These findings suggest that fatigue, anorexia-cachexia, and depression may share a common pathophysiologic basis. Further studies are needed to investigate this cluster and target anti-inflammatory therapies. The Oncologist 2016; 21:384-390Implications for Practice: Results of this preliminary study suggest that fatigue-anorexia/cachexia/depression cluster scores significantly improved in the dexamethasone treatment group as compared with placebo.These findings indicate that symptoms in the fatigue/anorexia-cachexia/depression cluster might share a common causative mechanism. Further studies are needed to validate these findings.

Conhecimento sobre cuidados paliativos entre médicos residentes de hospital universitário

“…Within 8 to 15 days after the onset of dexamethasone administration, fatigue, anorexia, and cachexia decreased, although the same did not occur with pain, anxiety, and depression. This fact shows that corticoids are beneficial to patients with nutritive restriction, reducing inflammatory cytokines and significantly increasing appetite 24 .…”

Efficacy of anti‐inflammatory treatment on major depressive disorder or depressive symptoms: meta‐analysis of clinical trials

“…We identified 39 studies covering 44 RCTs with a total of 10 891 individuals: 14 trials ( N = 4451) studied NSAIDs [five add‐ons , eight monotherapy except one trial where 45% of patients were on antidepressant medication ], 12 ( N = 3868) studied cytokine inhibitors [all as monotherapy except for one study where 62% of the patients were treated with antidepressants ], 9 ( N = 2118) studied statins [three add‐ons and six monotherapy ], 3 ( N = 119) studied pioglitazone as add‐on , 3 ( N = 162) studied minocycline [two add‐ons and one monotherapy ], and 3 ( N = 173) studied glucocorticoids as monotherapy . Of these, eight RCTs could not be included since we did not have access to the necessary data, neither published or after contact to the authors. Hence, a total of 31 studies covering 36 trials were included in the analyses.…”

The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer

“…The primary trial found no evidence of an analgesic effect of methylprednisolone 32 mg daily for cancer pain [ 17 ]. Another trial found only a temporary effect of systemic corticosteroids on pain intensity [ 16 , 47 ]. This is in contrast to a previous cross-over trial [ 19 ], in which 28 patients with predominantly bone localized pain (n = 16), visceral (n = 7) or nerve compression pain (n = 5) and low level of opioids showed response in pain intensity and analgesic consumption to methylprednisolone 32 mg daily.…”