Sriram Yennurajalingam1, Eduardo Bruera. 1. Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abstract
PURPOSE OF REVIEW: Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects. RECENT FINDINGS: Only two placebo-controlled double-blinded randomized studies on corticosteroid for symptoms that met the inclusion criteria were published recently, despite the criteria being extended beyond 2012 and 2013. These two studies confirm the preliminary data that corticosteroids significantly improve cancer-related fatigue and anorexia with no significant side-effects. However, these studies were of short duration. Long-term use of corticosteroids is not recommended at this time because of the risk of debilitating side-effects and no evidence of its long-term benefits. Recent studies also suggest the possible role of corticosteroid rotation or switching similar to opioid rotation for improvement of these side-effects. SUMMARY: Recent studies confirm the short-term benefit of corticosteroids for the symptomatic treatment of cancer-related fatigue and anorexia cachexia in advanced incurable cancer. Future studies are needed to determine the optimal dose, type, and the role of corticosteroid rotation so as to optimize long-term efficacy and minimize side-effects.
PURPOSE OF REVIEW: Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects. RECENT FINDINGS: Only two placebo-controlled double-blinded randomized studies on corticosteroid for symptoms that met the inclusion criteria were published recently, despite the criteria being extended beyond 2012 and 2013. These two studies confirm the preliminary data that corticosteroids significantly improve cancer-related fatigue and anorexia with no significant side-effects. However, these studies were of short duration. Long-term use of corticosteroids is not recommended at this time because of the risk of debilitating side-effects and no evidence of its long-term benefits. Recent studies also suggest the possible role of corticosteroid rotation or switching similar to opioid rotation for improvement of these side-effects. SUMMARY: Recent studies confirm the short-term benefit of corticosteroids for the symptomatic treatment of cancer-related fatigue and anorexia cachexia in advanced incurable cancer. Future studies are needed to determine the optimal dose, type, and the role of corticosteroid rotation so as to optimize long-term efficacy and minimize side-effects.
Authors: Sriram Yennurajalingam; Karen Basen-Engquist; James M Reuben; Bryan M Fellman; Sanjay Shete; Rama Maddi; Janet L Williams; Rony Dev; David Hui; Eduardo Bruera Journal: Support Care Cancer Date: 2021-07-31 Impact factor: 3.603