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Predictors of responses to corticosteroids for anorexia in advanced cancer patients: a multicenter prospective observational study

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Abstract

Purpose

Although corticosteroids are widely used to relieve anorexia, information regarding the factors predicting responses to corticosteroids remains limited. The purpose of the study is to identify potential factors predicting responses to corticosteroids for anorexia in advanced cancer patients.

Methods

Inclusion criteria for this multicenter prospective observational study were patients who had metastatic or locally advanced cancer and had an anorexia intensity score of 4 or more on a 0–10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting ≥2-point reduction in NRS on day 3.

Results

Among 180 patients who received corticosteroids, 99 (55 %; 95 % confidence interval [CI], 47–62 %) had a response with ≥2-point reduction. Factors that significantly predicted responses were Palliative Performance Scale (PPS) > 40 and absence of drowsiness. In addition, factors that tended to be associated with ≥2-point reduction in NRS included PS 0–3, absence of diabetes mellitus, absence of peripheral edema, presence of lung metastasis, absence of peritoneal metastasis, baseline anorexia NRS of >6, presence of pain, and presence of constipation. A multivariate analysis showed that the independent factors predicting responses were PPS of >40 (odds ratio = 2.7 [95 % CI = 1.4–5.2]), absence of drowsiness (2.6 [1.3–5.0]), and baseline NRS of >6 (2.4 [1.1–4.8]).

Conclusions

Treatment responses to corticosteroids for anorexia may be predicted by PPS, drowsiness, and baseline symptom intensity. Larger prospective studies are needed to confirm these results.

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References

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

    Article  Google Scholar 

  2. Seow H, Barbera L, Dudgeon D, Howell D, Husain A, Atzema C, Sussman J, Liu Y, Earle C, Sutradhar R (2011) Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol 29:1151–1158. doi:10.1200/JCO.2010.30.7173

    Article  PubMed  Google Scholar 

  3. Moertel CG, Schutt AJ, Reitemeier RJ, Hahn RG (1974) Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 33:1607–1609

    Article  CAS  PubMed  Google Scholar 

  4. Bruera E, Roca E, Cedaro L, Carraro S, Chacon R (1985) Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treat Rep 69:751–754

    CAS  PubMed  Google Scholar 

  5. Willox JC, Corr J, Shaw J, et al. (1984) Prednisolone as an appetite stimulant in patients with cancer. Br Med J (Clin Res Ed) 288:27

    Article  CAS  Google Scholar 

  6. Della Cuna GR, Pellegrini A, Piazzi M (1989) 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 25:1817–1821

    Article  CAS  PubMed  Google Scholar 

  7. Popiela T, Lucchi R, Giongo F (1989) Methylprednisolone as palliative therapy for female terminal cancer patients. The methylprednisolone female preterminal cancer study group. Eur J Cancer Clin Oncol 25:1823–1829

    Article  CAS  PubMed  Google Scholar 

  8. Bruera E, Moyano JR, Sala R, Rico MA, Bosnjak S, Bertolino M, Willey J, Strasser F, Palmer JL (2004) Dexamethasone in addition to metoclopramide for chronic nausea in patients with advanced cancer: a randomized controlled trial. J Pain Symptom Manag 28:381–388

    Article  CAS  Google Scholar 

  9. Inoue A, Yamada Y, Matsumura Y, Shimada Y, Muro K, Gotoh M, Hamaguchi T, Mizuno T, Shirao K (2003) Randomized study of dexamethasone treatment for delayed emesis, anorexia and fatigue induced by irinotecan. Support Care Cancer 11:528–532

    Article  PubMed  Google Scholar 

  10. Currow DC, Plummer J, Frith P, Abernethy AP (2007) Can we predict which patients with refractory dyspnea will respond to opioids? J Palliat Med 10:1031–1036

    Article  PubMed  Google Scholar 

  11. Currow DC, Rowett D, Doogue M, To TH, Abernethy AP (2012) An international initiative to create a collaborative for pharmacovigilance in hospice and palliative care clinical practice. J Palliat Med 15:282–286. doi:10.1089/jpm.2012.9605

    PubMed  Google Scholar 

  12. Matsuo N, Morita T, Iwase S (2011) Efficacy and undesirable effects of corticosteroid therapy experienced by palliative care specialists in Japan: a nationwide survey. J Palliat Med 14:840–845. doi:10.1089/jpm.2011.0002

    Article  PubMed  Google Scholar 

  13. Matsuo N, Morita T, Matsuda Y, et al. Predictors of responses to corticosteroids for cancer-related fatigue in advanced cancer patients: A multicenter prospective observational study. J Pain Symptom Manage. In press

  14. Selby D, Cascella A, Gardiner K, Do R, Moravan V, Myers J, Chow E (2010) A single set of numerical cutpoints to define moderate and severe symptoms for the Edmonton symptom assessment system. J Pain Symptom Manag 39:241–249. doi:10.1016/j.jpainsymman

    Article  Google Scholar 

  15. Matsuo N, Morita T, Iwase S (2012) Physician-reported corticosteroid therapy practices in certified palliative care units in Japan: a nationwide survey. J Palliat Med 15:1011–1016. doi:10.1089/jpm.2011.0534

    Article  PubMed  Google Scholar 

  16. Lundström SH, Fürst CJ (2006) The use of corticosteroids in Swedish palliative care. Acta Oncol 45:430–437

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  18. Mercadante S, Fulfaro F, Casuccio A (2001) The use of corticosteroids in home palliative care. Support Care Cancer 9:386–389

    Article  CAS  PubMed  Google Scholar 

  19. Okuyama T, Wang XS, Akechi T, Mendoza TR, Hosaka T, Cleeland CS, Uchitomi Y (2003) Japanese version of the MD Anderson symptom inventory: a validation study. J Pain Symptom Manag 26:1093–1104

    Article  Google Scholar 

  20. Morita T, Tsunoda J, Inoue S, Chihara S (1999) Validity of the palliative performance scale from a survival perspective. J Pain Symptom Manag 18:2–3

    Article  CAS  Google Scholar 

  21. Miyashita M, Matoba K, Sasahara T, Kizawa Y, Maruguchi M, Abe M, Kawa M, Shima Y (2004) Reliability and validity of the Japanese version of the support team assessment schedule (STAS-J). Palliat Support Care 2:379–385

    Article  PubMed  Google Scholar 

  22. American Psychiatric Association (2000) Mood Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, pp 369–382

  23. Bedard G, Zeng L, Zhang L, Lauzon N, Holden L, Tsao M, Danjoux C, Barnes E, Sahgal A, Poon M, Chow E (2013) Minimal clinically important differences in the Edmonton symptom assessment system in patients with advanced cancer. J Pain Symptom Manag 46:192–200. doi:10.1016/j.jpainsymman.2012.07.022

    Article  Google Scholar 

  24. Hui D, Shamieh O, Paiva CE, Perez-Cruz PE, Kwon JH, Muckaden MA, Park M, Yennu S, Kang JH, Bruera E (2015) Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: a prospective, multicenter study. Cancer 121:3027–3035. doi:10.1002/cncr.29437

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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 (2013) Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol 31:3076–3082. doi:10.1200/JCO.2012.44.4661

    Article  CAS  PubMed  Google Scholar 

  26. Paulsen O, Klepstad P, Rosland JH, Aass N, Albert E, Fayers P, Kaasa S (2014) 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 32:3221–3228. doi:10.1200/JCO.2013.54.3926

    Article  CAS  PubMed  Google Scholar 

  27. Denton A, Shaw J (2014) Corticosteroid prescribing in palliative care settings: a retrospective analysis in New Zealand. BMC Palliat Care 13:7. doi:10.1186/1472-684X-13-7

    Article  PubMed  PubMed Central  Google Scholar 

  28. Needham PR, Daley AG, Lennard RF (1992) Steroids in advanced cancer: survey of current practice. BMJ 305:999

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y, Uchitomi Y (2004) Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol 22:1957–1965

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research is (partially) supported by the Practical Research for Innovative Cancer Control from Japan Agency for Medical Research and Development, AMED.

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Authors and Affiliations

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

    Naoki Matsuo

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

    Tatsuya Morita

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

    Yoshinobu Matsuda

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

    Kenichiro Okamoto

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

    Yoshihisa Matsumoto

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

    Keisuke Kaneishi

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

    Takuya Odagiri

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

    Hiroki Sakurai

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

    Hideki Katayama

  10. Gratia Hospital Hospice, 6-14-1 Aomadaninishi, Mino, Osaka, 562-8567, Japan

    Ichiro Mori

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

    Hirohide Yamada

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

    Hiroaki Watanabe

  13. Department of Palliative Medicine, Yokohama Municipal Citizens Hospital, 56, Okazawa-cho, Hodogaya-ku, Yokohama, Kanagawa, 240-8555, Japan

    Taro Yokoyama

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

    Takashi Yamaguchi

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

    Tomohiro Nishi

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

    Akemi Shirado

  17. Department of Oncology, Mitsubishi Kyoto Hospital, Katsura Goshocho1, Nisikyo-ku, Kyoto, 615-8087, Japan

    Shuji Hiramoto

  18. Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama, Toyama, 930-8550, Japan

    Toshio Watanabe

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

    Hiroyuki Kohara

  20. Department of Palliative Care, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan

    Satofumi Shimoyama

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

    Etsuko Aruga

  22. Palliative Care Division, Saito Yukoukai Hospital, 7-2-18 Saito Asagi, Ibaragi, Osaka, 567-0085, Japan

    Mika Baba

  23. Matsue City Hospital, 32-1, Noshira-cho, Matsue, Shimane, 690-8509, Japan

    Koki Sumita

  24. 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. Naoki Matsuo
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  2. Tatsuya Morita
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Correspondence to Naoki Matsuo.

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Matsuo, N., Morita, T., Matsuda, Y. et al. Predictors of responses to corticosteroids for anorexia in advanced cancer patients: a multicenter prospective observational study. Support Care Cancer 25, 41–50 (2017). https://doi.org/10.1007/s00520-016-3383-z

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  • DOI: https://doi.org/10.1007/s00520-016-3383-z

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