Side effects of corticosteroids in patients with advanced cancer: a systematic review
- 568 Downloads
Corticosteroids are commonly used in palliative care settings, but are associated with several side effects. Although adverse events (AEs) are highly distressing for patients, few data are available from prospective studies to look at incidence or predictors of such harms. The aim of this study is to identify AE reporting among studies of patients with advanced cancer receiving corticosteroids for any reason.
A systematic review was conducted using the following data sources: PubMed, Medline, SCOPUS, Cochrane reviews, and CINAHL. Randomized controlled trials (RCTs) with patients with advanced cancer assessing the effect of corticosteroids were included. Consecutive cohort observational studies of corticosteroid toxicities in cancer patients were also included.
Twenty-seven RCTs and 12 consecutive cohort observational studies were identified. The most frequently reported primary outcome of RCTs was nausea and vomiting (8/27). Dexamethasone was prescribed in almost half of RCTs (13/27). In consecutive cohort studies, the primary outcomes were a wide variety of symptoms. Dexamethasone was also the most common glucocorticoid used (7/12). In terms of quality of AE reporting, two RCTs and one consecutive cohort study used a validated AE assessment tool in their studies.
Side effects of corticosteroids in advanced cancer patients were poorly reported with few data using validated tools. Researchers should be aware of the guideline of AE reporting to provide the best evidence of risk-benefit balance. Developing specific consensus guidelines about AE reporting in studies of glucocorticoids in studies of people with advanced cancer would be useful.
KeywordsCorticosteroids Adverse event reporting Advanced cancer patients Systematic review Palliative care
We thank Mikaela Lawrence, a librarian who assisted us in the search filtering.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
- 3.Nauck F, Ostgathe C, Klaschik E, Bausewein C, Fuchs M, Lindena G, Neuwöhner K, Schulenberg D, Radbruch L, Working Group on the Core Documentation for Palliative Care Units in Germany (2004) Working group on the core documentation for palliative care units in Germany. Drugs in palliative care: results from a representative survey in Germany. Palliat Med 18:100–107CrossRefGoogle Scholar
- 8.Hatano Y, Currow DC, Matsuoka H (2015) Psychotropic side effect of corticosteroids in advanced cancer: a systematic review and meta-analysis. PROSPERO 2015:CRD42015025813 Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025813 [accessed 13 Dec 2017]Google Scholar
- 10.Cochrane handbook for systematic reviews of interventions. Available from: http://training.cochrane.org/handbook
- 11.National Institute of Health, National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Available from https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm (accessed 13 Dec 2017)
- 13.Meghelli L, Narducci F, Mariette C, Piessen G, Vanseymortier M, Leblanc E, Collinet P, Duhamel A, Penel N (2016) Reporting adverse events in cancer surgery randomized trials: a systematic review of published trials in oesophago-gastric and gynecological cancer patients. Crit Rev Oncol Hematol 104:108–114CrossRefGoogle Scholar
- 14.Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) Available from: https://healthcaredelivery.cancer.gov/pro-ctcae/ (accessed 13 Dec 2017)
- 15.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 31:3076–3082CrossRefGoogle Scholar