Clinical Drug Investigation

, Volume 37, Issue 4, pp 387–392 | Cite as

Predictors of the Usefulness of Corticosteroids for Cancer-Related Fatigue in End-of-Life Patients

Original Research Article


Background and Objectives

Although some studies have examined the use of corticosteroids, their effectiveness in treating cancer-related fatigue (CRF) has yet to be established. Therefore, this retrospective study attempted to identify factors that would predict the usefulness of corticosteroids in treating CRF.


We examined 87 hospitalized end-of-life cancer patients who were given betamethasone for relief of CRF at our hospital between January 2008 and January 2014. We evaluated the effect of betamethasone at 3 days after administration and performed a multivariate logistic regression analysis designed to identify predictive factors for the usefulness of corticosteroids. Threshold measurements were examined using a receiver operating characteristic (ROC) curve.


This analysis identified the initial daily dose of betamethasone [odds ratio (OR) = 1.662], days from the start date of betamethasone administration to the date of death (OR = 1.05), administration of fentanyl (OR = 0.206) and age (OR = 1.055) as significant factors related to the effect of betamethasone. ROC curve analysis of the effect of the betamethasone showed that the threshold for the initial daily dose of betamethasone was above 4 mg, the threshold for the days from the start date of the betamethasone administration to the date of death was above 16 days and the threshold for age was above 60 years old.


The initial daily dose of betamethasone, days from the start date of the betamethasone administration to the date of death, non-administration of fentanyl and advanced age were shown to be predictive factors for the usefulness of corticosteroids for CRF in end-of-life patients.


  1. 1.
    Mücke M, Mochamat, Cuhls H, Peuckmann-Post V, Minton O, Stone P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database Syst Rev. 2015;5:CD006788.Google Scholar
  2. 2.
    Yennurajalingam S, Bruera E. Review of clinical trials of pharmacologic interventions for cancer-related fatigue: focus on psychostimulants and steroids. Cancer J. 2014;20:319–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Lundström S, Fürst CJ, Friedrichsen M, Strang P. The existential impact of starting corticosteroid treatment as symptom control in advanced metastatic cancer. Palliat Med. 2009;23:165–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Lundström SH, Fürst CJ. The use of corticosteroids in Swedish palliative care. Acta Oncol. 2006;45:430–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Gannon C, McNamara P. A retrospective observation of corticosteroid use at the end of life in a hospice. J Pain Symptom Manag. 2002;24:328–34.CrossRefGoogle Scholar
  6. 6.
    Mercadante S, Fulfaro F, Casuccio A. The use of corticosteroids in home palliative care. Support Care Cancer. 2001;9:386–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Shih A, Jackson KC. Role of corticosteroids in palliative care. J Pain Palliat Care Pharmacother. 2007;21:69–76.CrossRefPubMedGoogle Scholar
  8. 8.
    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;15:3–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, Krook JE, Wilwerding MB, Rowland KM Jr, Camoriano JK, Novotny PJ, Christensen BJ. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol. 1999;17:3299–306.CrossRefPubMedGoogle Scholar
  10. 10.
    Hanks GW, Trueman T, Twycross RG. Corticosteroids in terminal cancer: a prospective analysis of current practice. Postgrad Med J. 1983;59:702–6.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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;69:751–4.PubMedGoogle Scholar
  12. 12.
    Della Cuna GR, Pellegrini A, Piazzi M, The Methylprednisolone Preterminal Cancer Study Group. Effect of methylprednisolone sodium succinate on quality of life in preterminal cancer patients: a placebo-controlled, multicenter study. Eur J Cancer Clin Oncol. 1989;25:1817–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Yennurajalingam S, Frisbee-Hume S, Palmer JL, Delgado-Guay MO, Bull J, Phan AT, Tannir NM, Litton JK, Reddy A, Hui D, Dalal S, Massie L, Reddy SK, Bruera E. Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol. 2013;31:3076–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Matsuo N, Morita T, Iwase S. Efficacy and undesirable effects of corticosteroid therapy experienced by palliative care specialists in Japan: a nationwide survey. J Palliat Med. 2011;14:840–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Matsuo N, Morita T, Iwase S. Physician-reported corticosteroid therapy practices in certified palliative care units in Japan: a nationwide survey. J Palliat Med. 2012;15:1011–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr. 2007;96:644–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Spathis A, Booth S, Grove S, Hatcher H, Kuhn I, Barclay S. Teenage and young adult cancer-related fatigue is prevalent, distressing, and neglected: it is time to intervene. A systematic literature review and narrative synthesis. J Adolesc Young Adult Oncol. 2015;4:3–17.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol. 2008;26:2396–404.CrossRefPubMedGoogle Scholar
  19. 19.
    Viola R, Kiteley C, Lloyd NS, Mackay JA, Wilson J, Wong RK, Supportive Care Guidelines Group of the Cancer Care Ontario Program in Evidence-Based Care. Supportive care guidelines group of the cancer care Ontario program in evidence-based care. The management of dyspnea in cancer patients: a systematic review. Support Care Cancer. 2008;16:329–37.CrossRefPubMedGoogle Scholar
  20. 20.
    Simon ST, Köskeroglu P, Gaertner J, Voltz R. Fentanyl for the relief of refractory breathlessness: a systematic review. J Pain Symptom Manag. 2013;46:874–86.CrossRefGoogle Scholar
  21. 21.
    Kanbayashi Y, Hosokawa T, Okamoto K, Fujimoto S, Konishi H, Otsuji E, Yoshikawa T, Takagi T, Miki T, Taniwaki M. Factors predicting requirement of high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone in patients with cancer pain. Clin J Pain. 2011;27:664–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Hospital Pharmacy, University HospitalKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Pain Treatment and Palliative Care Unit, University HospitalKyoto Prefectural University of MedicineKyotoJapan
  3. 3.Department of Pain Management and Palliative Care MedicineKyoto Prefectural University of MedicineKyotoJapan

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