Steroids in advanced cancer: survey of current practice.

Abstract

American studies suggest that appropriate measures of abusive behaviours can be achieved. However, pilot studies with in depth interviews at our hospital found several methodological problems. These included the obtaining of informed consent to participate in research on family violence, access to potential respondents, and ethical dilemmas about procedure if abuse is uncovered during research. Further British research will therefore need to address these problems before large scale studies of elder abuse are conducted.We acknowledge the support of Channel 4 and the Office of Population Censuses and Surveys omnibus survey team in undertaking this survey.

The use of corticosteroids in Swedish palliative care

“…Few physicians had local guidelines on treatment with corticosteroids in advanced cancer. Earlier studies have stressed the need for guidelines, and given the frequency of use and the potentially serious adverse side effects associated with corticosteroid treatment, implementation of guidelines are important [6,7,11]. The results in both surveys were coherent regarding the proportion of patients treated, drugs and dosages, assessed effects and side effects.…”

“…Dexamethasone is the drug of choice and the doses varies between 0.5 mg on alternate days to 16 mg daily [6Á 8,10,11]. Most of the studies show a positive but short lasting effect in a majority of treated patients, however one study claimed positive beneficial effect in less than 30% of the patients [6]. Is this widespread use of corticosteroids in palliative care based on evidence or does it merely reflect treatment traditions in lack of controlled trials?…”

“…Close monitoring of the patient using the lowest effective dose and discontinuing if no benefit is obtained is recommended [6,7].…”

The use of corticosteroids in home palliative care

“…Whether or not corticosteroid treatment is truly and consistently effective in palliative care remains quite controversial, and this point should be clarified. Many patients are receiving corticosteroid treatment without the establishment of precise indications and without adequate monitoring [5]. Before conducting randomized controlled double-blind studies on the effectiveness of corticosteroids in controlling a specific symptom, we felt it would be useful to determine the areas in which corticosteroids may potentially be helpful by means of open-label longitudinal studies.…”

Highlights of the 4th San Salvatore Meeting on Palliative Care, Lugano and St. Gallen, Switzerland, 23–25 October 2001

“…Lowdose dexamethasone (4-8 mg/day) could have salutary effects in the management of cancer-related anorexiacachexia as well as in fatigue, nausea and vomiting, by increasing subjective well-being [18,20,21,28].…”