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Do Patients Benefit from a Trial of Corticosteroids at the End of Life?

  • Palliative and Supportive Care (J Hardy, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Patients with advanced cancer in the last 6 months of their lives have a higher frequency of distressing and debilitating physical and psychosocial symptoms such as cancer pain, cancer-related fatigue (CRF), anorexia, shortness of breath, poor sleep, anxiety, and depression. Often these symptoms significantly impact the patients’ quality of life, and therefore require prompt assessment and effective treatment. There are specific treatments for certain distressing cancer-related symptoms (e.g., opioids for pain), but for the other symptoms such as CRF, anorexia-cachexia, and shortness of breath, there are limited or no evidence-based treatments. Also, in the management of cancer pain in this population, many patients are refractory to opioids. Hence, corticosteroids are one of the most common adjuvant medications prescribed for the management of this distressing symptom. However, there is limited evidence in regard to the effectiveness of corticosteroids in the improvement of the symptoms, side-effect profile, most optimal duration of use, dose, type of steroid, and most recently, the use with immunotherapy in advanced cancer patients at the end of life. These factors significantly limit the use of this important medication in terminally ill cancer patients. Further research is therefore critical to provide the optimal prescription of corticosteroids in this highly distressed population.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manag. 2006;31(1):58–69.

    Article  Google Scholar 

  2. Cheung WY, Barmala N, Zarinehbaf S, Rodin G, Le LW, Zimmermann C. The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manag. 2009;37(3):297–304.

    Article  Google Scholar 

  3. Batra A, Yang L, Boyne DJ, Harper A, Cuthbert CA, Cheung WY. Symptom burden in patients with common cancers near end-of-life and its associations with clinical characteristics: a real-world study. Support Care Cancer : Off J Multinatl Assoc Support Care in Cancer. 2021;29(6):3299–309.

    Article  Google Scholar 

  4. Seow H, Barbera L, Sutradhar R, Howell D, Dudgeon D, Atzema C, et al. Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol. 2011;29(9):1151–8.

    Article  PubMed  Google Scholar 

  5. Yennurajalingam S, Kwon JH, Urbauer DL, Hui D, Reyes-Gibby CC, Bruera E. Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center. Palliat Support Care. 2013;11(6):473–80.

    Article  PubMed  Google Scholar 

  6. Oechsle K, Wais MC, Vehling S, Bokemeyer C, Mehnert A. Relationship between symptom burden, distress, and sense of dignity in terminally ill cancer patients. J Pain Symptom Manag. 2014;48(3):313–21.

    Article  Google Scholar 

  7. Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88–93.

    Article  CAS  PubMed  Google Scholar 

  8. Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative care and the management of common distressing symptoms in advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. J Clin Oncol. 2020;38(9):905–14.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lundström SH, Fürst CJ. The use of corticosteroids in Swedish palliative care. Acta Oncol. 2006;45(4):430–7.

    Article  PubMed  CAS  Google Scholar 

  10. Denton A, Shaw J. Corticosteroid prescribing in palliative care settings: a retrospective analysis in New Zealand. BMC Palliat Care. 2014;13(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yennurajalingam S, Urbauer DL, Casper KLB, Reyes-Gibby CC, Chacko R, Poulter V, et al. Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. J Pain Symptom Manag. 2011;41(1):49–56.

    Article  Google Scholar 

  12. Yennurajalingam S, Bruera E. Review of clinical trials of pharmacologic interventions for cancer-related fatigue: focus on psychostimulants and steroids. Cancer J (Sudbury, Mass). 2014;20(5):319–24.

    Article  CAS  Google Scholar 

  13. Furst DE and Saag KG. Determinants of glucocorticoid dosing. In: UpToDate. Waltham: UpToDate Inc. 2021https://www.uptodate.com/contents/determinants-of-glucocorticoid-dosing. Accessed October 01, 2021.

  14. Schimmer BP, Funder JW. ACTH, adrenal steroids, and pharmacology of the adrenal cortex. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill Education; 2011.

    Google Scholar 

  15. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma Clin Immunol. 2013;9(1):30. Published 2013 Aug 15. https://doi.org/10.1186/1710-1492-9-30.

  16. Aldea M, Orillard E, Mansi L, Marabelle A, Scotte F, Lambotte O, et al. How to manage patients with corticosteroids in oncology in the era of immunotherapy? Eur J Cancer. 2020;141:239–51.

    Article  CAS  PubMed  Google Scholar 

  17. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids — new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711–23.

    Article  CAS  PubMed  Google Scholar 

  18. Tischner D, Reichardt HM. Glucocorticoids in the control of neuroinflammation. Mol Cell Endocrinol. 2007;275(1-2):62–70.

    Article  CAS  PubMed  Google Scholar 

  19. Riedemann T, Patchev AV, Cho K, Almeida OFX. Corticosteroids: way upstream. Mol Brain. 2010;3(1):2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Sorrells SF, Sapolsky RM. An inflammatory review of glucocorticoid actions in the CNS. Brain Behav Immun. 2007;21(3):259–72.

    Article  CAS  PubMed  Google Scholar 

  21. Kawashima K, Fujii T, Moriwaki Y, Misawa H. Critical roles of acetylcholine and the muscarinic and nicotinic acetylcholine receptors in the regulation of immune function. Life Sci. 2012;91(21-22):1027–32.

    Article  CAS  PubMed  Google Scholar 

  22. Krugers HJ, Karst H, Joels M. Interactions between noradrenaline and corticosteroids in the brain: from electrical activity to cognitive performance. Front Cell Neurosci. 2012;6:15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Li C, Liu S, Lu X, Tao F. Role of descending dopaminergic pathways in pain modulation. Curr Neuropharmacol. 2019;17:1176–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;2000(2):Cd001219.

    PubMed Central  Google Scholar 

  25. Austin PJ, Moalem-Taylor G. The neuro-immune balance in neuropathic pain: involvement of inflammatory immune cells, immune-like glial cells and cytokines. J Neuroimmunol. 2010;229(1-2):26–50.

    Article  CAS  PubMed  Google Scholar 

  26. Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open. 2014;4(5):e004587.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991;114(9):735–40.

    Article  CAS  PubMed  Google Scholar 

  28. Gutthann SP, García Rodríguez LA, Raiford DS. Individual nonsteroidal antiinflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation. Epidemiology (Cambridge, Mass). 1997;8(1):18–24.

    Article  CAS  Google Scholar 

  29. Garcia Rodríguez LA, Hernández-Díaz S. The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents. Arthritis Res. 2001;3(2):98–101.

    Article  PubMed  Google Scholar 

  30. Munson JC, Wahl PM, Daniel G, Kimmel SE, Hennessy S. Factors associated with the initiation of proton pump inhibitors in corticosteroid users. Pharmacoepidemiol Drug Saf. 2012;21(4):366–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hardy JR, Rees E, Ling J, Burman R, Feuer D, Broadley K, Stone P. A prospective survey of the use of dexamethasone on a palliative care unit. Palliat Med. 2001;15(1):3–8.

    Article  CAS  PubMed  Google Scholar 

  32. Sturdza A, Millar B-A, Bana N, Laperriere N, Pond G, Wong RS, et al. The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer. 2008;16(9):1041–8.

    Article  PubMed  Google Scholar 

  33. Batchelor TTTL, Thaler HT, Posner JB, DeAngelis LM. Steroid myopathy in cancer patients. Neurology. 1997;48(5):1234–8.

    Article  CAS  PubMed  Google Scholar 

  34. Schakman O, Kalista S, Barbé C, Loumaye A, Thissen JP. Glucocorticoid-induced skeletal muscle atrophy. Int J Biochem Cell Biol. 2013;45(10):2163–72.

    Article  CAS  PubMed  Google Scholar 

  35. Pereira RMR, Freire de Carvalho J. Glucocorticoid-induced myopathy. Joint Bone Spine. 2011;78(1):41–4.

    Article  CAS  PubMed  Google Scholar 

  36. Gupta AGY. Glucocorticoid-induced myopathy: pathophysiology, diagnosis, and treatment. Indian J Endocrinol Metab. 2013;17(5):913–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. La Pier TK. Glucocorticoid-induced muscle atrophy: the role of exercise in treatment and prevention. J Cardpulm Rehabil. 1997;17:76–84.

    Article  Google Scholar 

  38. Braith RWWM, Mills RM Jr, Keller JW, Pollock ML. Resistance exercise prevents glucocorticoid-induced myopathy in heart transplant recipients. Med Sci Sports Exerc. 30(4):483–9.

  39. Hardy J, Haywood A, Rickett K, Sallnow L, Good P. Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med. 2021;35(3):461–72.

    Article  PubMed  Google Scholar 

  40. Price D, Castro M, Bourdin A, Fucile S, Altman P. Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety. Eur Respir Rev. 2020;29(155):190151.

    Article  PubMed  Google Scholar 

  41. Walters JA, Tan DJ, White CJ, Wood-Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;3(3):CD006897.

    PubMed  Google Scholar 

  42. Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AGM. Short-course oral steroids alone for chronic rhinosinusitis. Cochrane Database of Syst Rev 2016; (4).

  43. Miller S, McNutt L, McCann MA, McCorry N. Use of corticosteroids for anorexia in palliative medicine: a systematic review. J Palliat Med. 2014;17(4):482–5.

    Article  PubMed  Google Scholar 

  44. Moertel CG, Schutt AJ, Reitemeier RJ, Hahn RG. Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer. 1974;33(6):1607–9.

    Article  CAS  PubMed  Google Scholar 

  45. Bruera E, Roca E, Cedaro L, Carraro S, Chacon R. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treat Rep. 1985;69(7-8):751–4.

    CAS  PubMed  Google Scholar 

  46. Willox JC, Corr J, Shaw J, Richardson M, Calman KC, Drennan M. Prednisolone as an appetite stimulant in patients with cancer. Br Med J (Clin Res Ed). 1984;288(6410):27.

    Article  CAS  Google Scholar 

  47. Metz CA, Popiela T, Lucchi R, Giongo F. Methylprednisolone as palliative therapy for female terminal cancer patients. Eur J Cancer Clin Oncol. 1989;25(12):1823–9.

    Article  Google Scholar 

  48. Popiela T, Lucchi R, Giongo F. Methylprednisolone as palliative therapy for female terminal cancer patients. The Methylprednisolone Female Preterminal Cancer Study Group. Eur J Cancer Clin Oncol. 1989;25(12):1823–9.

    Article  CAS  PubMed  Google Scholar 

  49. Currow DC, Glare P, Louw S, Martin P, Clark K, Fazekas B, et al. A randomised, double blind, placebo-controlled trial of megestrol acetate or dexamethasone in treating symptomatic anorexia in people with advanced cancer. Sci Rep. 2021;11(1):2421.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Roeland EJ, Bohlke K, Baracos VE, Bruera E, del Fabbro E, Dixon S, et al. Management of cancer cachexia: ASCO Guideline. J Clin Oncol. 2020;38(21):2438–53.

    Article  CAS  PubMed  Google Scholar 

  51. Lim FMY, Bobrowski A, Agarwal A, Silva MF. Use of corticosteroids for pain control in cancer patients with bone metastases: a comprehensive literature review. Curr Opin Support Palliat Care. 2017;11(2):78–87.

    Article  PubMed  Google Scholar 

  52. White P, Arnold R, Bull J, Cicero B. The use of corticosteroids as adjuvant therapy for painful bone metastases: a large cross-sectional survey of palliative care providers. Am J Hosp Palliat Care. 2018;35(1):151–8.

    Article  PubMed  Google Scholar 

  53. Haywood A, Good P, Khan S, Leupp A, Jenkins-Marsh S, Rickett K, et al. Corticosteroids for the management of cancer-related pain in adults. Cochrane Database Syst Rev. 2015;2015(4):Cd010756.

    PubMed Central  Google Scholar 

  54. Paulsen O, Klepstad P, Rosland JH, Aass N, Albert E, Fayers P, et al. Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol : Off J Am Soc Clin Oncol. 2014;32(29):3221–8.

    Article  CAS  Google Scholar 

  55. Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(27):3325–45.

    Article  PubMed  Google Scholar 

  56. Tomlinson D, Robinson PD, Oberoi S, Cataudella D, Culos-Reed N, Davis H, et al. Pharmacologic interventions for fatigue in cancer and transplantation: a meta-analysis. Curr Oncol (Toronto, Ont). 2018;25(2):e152–e67.

    Article  CAS  Google Scholar 

  57. Mücke M, Cuhls H, Peuckmann-Post V, Minton O, Stone P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database Syst Rev. 2015;2015(5):Cd006788.

    PubMed Central  Google Scholar 

  58. Yennurajalingam S, Frisbee-Hume S, Palmer JL, Delgado-Guay MO, Bull J, Phan AT, et al. Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol : Off J Am Soc Clin Oncol. 2013;31(25):3076–82.

    Article  CAS  Google Scholar 

  59. Haywood A, Duc J, Good P, Khan S, Rickett K, Vayne-Bossert P, et al. Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. Cochrane Database Syst Rev. 2019;2(2):Cd012704.

    PubMed  Google Scholar 

  60. Hui D, Kilgore K, Frisbee-Hume S, Park M, Tsao A, Delgado Guay M, et al. Dexamethasone for dyspnea in cancer patients: a pilot double-blind, randomized, controlled trial. J Pain Symptom Manag. 2016;52(1):8–16.e1.

    Article  Google Scholar 

  61. Razvi Y, Chan S, McFarlane T, McKenzie E, Zaki P, DeAngelis C, et al. ASCO, NCCN, MASCC/ESMO: a comparison of antiemetic guidelines for the treatment of chemotherapy-induced nausea and vomiting in adult patients. Support Care Cancer. 2019;27(1):87–95.

    Article  PubMed  Google Scholar 

  62. Vayne-Bossert P, Haywood A, Good P, Khan S, Rickett K, Hardy JR. Corticosteroids for adult patients with advanced cancer who have nausea and vomiting (not related to chemotherapy, radiotherapy, or surgery). Cochrane Database Syst Rev. 2017;7(7):Cd012002.

    PubMed  Google Scholar 

  63. • Hardy J, Davis MP. The management of nausea and vomiting not related to anticancer therapy in patients with cancer. Curr Treat Options in Oncol. 2021;22(2):17 This article is a updated review of the role of corticosteroids use for the treatment of chronic nausea in patients with advanced cancer.

    Article  Google Scholar 

  64. Della Cuna GR, Pellegrini A, Piazzi M. Effect of methylprednisolone sodium succinate on quality of life in preterminal cancer patients: a placebo-controlled, multicenter study. The Methylprednisolone Preterminal Cancer Study Group. Eur J Cancer Clin Oncol. 1989;25(12):1817–21.

    Article  CAS  PubMed  Google Scholar 

  65. Skeoch GD, Tobin MK, Khan S, Linninger AA, Mehta AI. Corticosteroid treatment for metastatic spinal cord compression: a review. Global Spine J. 2017;7(3):272–9.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Lin R, Adelmann R, Mehta S. Dyspnea in palliative care: expanding the role of corticosteroids. J Palliat Med. 2012;15:834–7.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Falk S, Fallon M. ABC of palliative care: emergencies. BMJ (Clinical research ed). 1998;315:1525–8.

    Article  Google Scholar 

  68. Yennurajalingam S, Valero V, Lim B, Booser DJ, Hernandez CD, Lu Z, et al. High/low dose dexamethasone with physical activity for cancer-related fatigue in patients with advanced cancer: a phase II randomized double blind study. J Natl Compr Cancer Netw. 2021;1-9. https://doi.org/10.6004/jnccn.2021.7066.

  69. Okishiro NTH, Tsuneto S, Ito N. Can “steroid switching” improve steroid-induced psychosis in a patient with advanced cancer? J Palliat Med. 2009;12(5):487–90.

    Article  PubMed  Google Scholar 

  70. Kang JH, Hui D, Kim MJ, Kim HG, Kang MH, Lee G-W, et al. Corticosteroid rotation to alleviate dexamethasone-induced hiccup: a case series at a single institution. J Pain Symptom Manag. 2012;43(3):625–30.

    Article  Google Scholar 

  71. Lee G-W, Oh SY, Kang MH, Kang JH, Park SH, Hwang IG, et al. Treatment of dexamethasone-induced hiccup in chemotherapy patients by methylprednisolone rotation. Oncologist. 2013;18(11):1229–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Arbour KC, Mezquita L, Long N, Rizvi H, Auclin E, Ni A, et al. Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death-ligand 1 blockade in patients with non-small-cell lung cancer. J Clin Oncol. 2018;36(28):2872–8.

    Article  CAS  PubMed  Google Scholar 

  73. •• De Giglio A, Mezquita L, Auclin E, Blanc-Durand F, Riudavets M, Caramella C, et al. Impact of intercurrent introduction of steroids on clinical outcomes in advanced non-small-cell lung cancer (NSCLC) patients under immune-checkpoint inhibitors (ICI). Cancers (Basel). 2020;12(10):2827 Evidence that the concomittant use of steroids and immunotherapy is associated with reduced survival outcomes.

    Article  CAS  Google Scholar 

  74. Drakaki A, Luhn P, Wakelee H, Dhillon PK, Kent M, Shim J, et al. 47O - Association of systemic corticosteroids with overall survival in patients receiving cancer immunotherapy for advanced melanoma, non-small cell lung cancer or urothelial cancer in routine clinical practice. Ann Oncol. 2019;30:xi16–xi7.

    Article  Google Scholar 

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  1. Department of Palliative Care Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. #1414, Houston, TX, 77030, USA

    Sriram Yennurajalingam MD, MS, FAAHPM & Eduardo Bruera MD, FAAHPM

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  1. Sriram Yennurajalingam MD, MS, FAAHPM
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  2. Eduardo Bruera MD, FAAHPM
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Correspondence to Sriram Yennurajalingam MD, MS, FAAHPM.

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Yennurajalingam, S., Bruera, E. Do Patients Benefit from a Trial of Corticosteroids at the End of Life?. Curr. Treat. Options in Oncol. 23, 796–805 (2022). https://doi.org/10.1007/s11864-022-00977-x

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