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Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study

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Abstract

Purpose

Although corticosteroids can relieve dyspnea in advanced cancer patients, factors predicting the response remain unknown. We aimed to explore potential factors predicting the response to corticosteroids for dyspnea in advanced cancer patients.

Methods

In this preliminary multicenter prospective observational study, we included patients who had metastatic or locally advanced cancer, were receiving specialized palliative care services, and had a dyspnea intensity of ≥3 on a 0–10 Numerical Rating Scale (NRS) (worst during the last 24 h). The primary endpoint was NRS of dyspnea on day 3 after the administration of corticosteroids. Univariate/multivariate analyses were conducted to identify factors predicting ≥1-point reduction in NRS.

Results

Of 74 patients who received corticosteroids, 50 (68%) showed ≥1-point reduction in dyspnea NRS. Factors that significantly predicted the response were an age of 70 years or older (82 vs. 53%, p = 0.008), absence of liver metastases (77 vs. 46%, p = 0.001), Palliative Prognostic Index (PPI) ≤ 6 (90 vs. 61%, p = 0.041), presence of pleuritis carcinomatosa with a small collection of pleural effusions (84 vs. 55%, p = 0.011), presence of audible wheezes (94 vs. 60%, p = 0.014), and baseline dyspnea NRS ≥7 (76% vs. 52%, p = 0.041). In a multivariate analysis, factors predicting response included PPI <6 (odds ratio (OR), 36.2; p = 0.021), baseline dyspnea NRS (worst) ≥7 (OR, 6.6; p = 0.036), and absence of liver metastases (OR, 0.19; p = 0.029) or ascites/liver enlargement (OR, 0.13; p = 0.050).

Conclusions

The patient characteristics, etiologies of dyspnea, and clinical manifestations may predict responses to corticosteroids for dyspnea. Larger prospective studies are promising to confirm our findings.

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Acknowledgments

This research in (partially) supported by the Practical Research for Innovative Cancer Control from Japan Agency for Medical Research and development, AMED (15ck0106059h0002).

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Authors and Affiliations

  1. Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Masanori Mori & Akemi Naito Shirado

  2. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  3. Palliative Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuduki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan

    Kenichiro Okamoto

  4. Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, 591-8555, Japan

    Yoshinobu Matsuda

  5. Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Yoshihisa Matsumoto

  6. Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan

    Hirohide Yamada

  7. Department of Palliative Care, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Hiroki Sakurai

  8. Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Etsuko Aruga

  9. Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku, Tokyo, 162-0815, Japan

    Keisuke Kaneishi

  10. Komaki City Hospital, 1-20 Jobushi, Komaki City, Aichi, 485-8520, Japan

    Hiroaki Watanabe & Takuya Odagiri

  11. Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Takashi Yamaguchi

  12. Department of Oncology, Katsura Goshocho1, Nisikyo-ku, Mitsubishi Kyoto Hospital, Kyoto, Japan

    Shuji Hiramoto

  13. Department of Palliative Care, Hiroshima Prefectural Hospital, 1-5-54,Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan

    Hiroyuki Kohara

  14. Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital, 42, Aza-Sangoden, Sotoasahikawa, Akita, 010-0802, Japan

    Naoki Matsuo

  15. NHO Yamaguchi-Ube Medical Center, 685, Higashi-Kiwa, Ube, Yamaguchi, 755-0241, Japan

    Hideki Katayama

  16. Kawasaki Municipal Ida Hospital, Nakahara-ku Ida 2-27-1, Kawasaki-shi, Kanagawa, Japan

    Tomohiro Nishi

  17. Department of Palliative Medicine, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan

    Takashi Matsui

  18. Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Satoru Iwase

Authors
  1. Masanori Mori
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  2. Akemi Naito Shirado
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  3. Tatsuya Morita
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  4. Kenichiro Okamoto
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  5. Yoshinobu Matsuda
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  6. Yoshihisa Matsumoto
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  7. Hirohide Yamada
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  8. Hiroki Sakurai
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  9. Etsuko Aruga
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  10. Keisuke Kaneishi
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  11. Hiroaki Watanabe
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  12. Takashi Yamaguchi
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  13. Takuya Odagiri
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  14. Shuji Hiramoto
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  15. Hiroyuki Kohara
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  16. Naoki Matsuo
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  17. Hideki Katayama
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  18. Tomohiro Nishi
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  19. Takashi Matsui
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  20. Satoru Iwase
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Corresponding author

Correspondence to Masanori Mori.

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Mori, M., Shirado, A.N., Morita, T. et al. Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study. Support Care Cancer 25, 1169–1181 (2017). https://doi.org/10.1007/s00520-016-3507-5

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