Dexamethasone – a popular steroid that is given to patients in advanced asthma, cancer, and other debilitating diseases, can reduce the stress and fatigue in cancer patients with advanced illness as suggested by the new study conducted by researchers of University of Texas MD Anderson Cancer Center in Houston.
Despite the projected benefits, it has been observed that dexamethasone is not used routinely in cancer patients. The survey conducted by National Comprehensive Cancer Network by collecting data from 1000 oncologists suggested that only one quarter to one third of oncologists prescribe steroids to manage fatigue in cancer patients.
The results of the randomized clinical trial were published online in the July 29 edition of the peer reviewed Journal of Clinical Oncology. The results suggested that dexamethasone can significantly improve the quality of life when administered to patients. It was also identified that the dexamethasone can improve physical well-being, and physical distress, when compared to placebo.
The lead author of the study, Sriram Yennurajalingam, suggested that while the research is still underway to study the long term benefits and safety of dexamethasone, it is definitely possible to administer the recommended dose in patients who are battling severe stress and fatigue in advanced cancer stages. Sriram Yennurajalingam is a professor at the Department of Palliative Care and Rehabilitation Medicine at the University of Texas MD Anderson Cancer Center in Houston.
Sriram Yennurajalingam explained the recommended dosage in these words: “It can be prescribed for about 1 to 2 weeks in all advanced cancer patients with significant cancer-related fatigue.”
However, it is not used much in this setting. In a recent survey of 1000 oncologists conducted by the National Comprehensive Cancer Network, just one quarter to one third of respondents said that they frequently use steroids to manage fatigue at the end of life.
Dr. Yennurajalingam explained:
“Dexamethasone is used on a limited basis in this setting because of concerns about side effects and lack of evidence in the form of clinical trials with fatigue as a primary outcome.”
The details of the study:
Dr. Yennurajalingam and his colleagues enrolled 84 patients in the study with the diagnosis of advanced cancer and at least 3 or more symptoms at frequent periodic intervals (i.e., pain, fatigue, chronic nausea and anorexia/cachexia, sleep problems, depression, or poor appetite). Yennurajalingam then advised oral dexamethasone (in a dose of 4 mg) or placebo twice daily for 14 days.
Patients were assessed on the day 15 on the Functional Assessment of Chronic Illness Therapy (FACIT-F) scale for symptoms of fatigue. Patients were also evaluated on, anxiety, depression, anorexia and symptom distress scores.
The results indicated that patients who were administered dexametasone performed significantly better on the FACIT-F score when compared to a placebo. Moreover, the patients on dexametasone also performed better on FACIT total quality-of-life score.
No significant difference was observed when other criteria are evaluated (like ESAS individual symptoms, psychological distress, and Hospital Anxiety and Depression Scale anxiety and depression scores).
Patients find dexamethaosone therapy satisfactory for pain and fatigue of advanced cancer disease. Researchers from Erasmus MC–Daniel den Hoed Cancer Center in Rotterdam, the Netherlands, Pleun J. de Raaf, MD, and Carin C.D. van der Rijt, suggested that both pharmacological and non-pharmacological agents are advised for the management of pain and fatigue symptoms in advanced cancer.
“Because fatigue in advanced cancer is not an isolated symptom, evaluation should begin with screening for concurrent symptoms in patients with moderate–severe fatigue. Furthermore, because fatigue may be secondary to a variety of complications resulting from the cancer, cancer treatment, or comorbid conditions, a targeted history, physical examination, and additional diagnostics must be considered depending on potential risks and benefits for the patient.”
They further proposed:
“In patients with fatigue that proves refractory to psychoeducation and simple symptom control, clinicians can recommend corticosteroids or methylphenidate. We propose the use of corticosteroids in situations with concurrent anorexia, nausea, or vomiting, or in those with corticosteroid responsive complications such as intracranial hypertension, hepatic distension, and lymphangitic carcinomatosis.”
Although the results are encouraging, it is a also recommended to prescribe dexamethasone to the patients who have limited life expectancy, since long-term use of steroids is associated with serious adverse effects.
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