Corticosteroid prescribing in palliative care settings: a retrospective analysis in New Zealand

Abstract

BackgroundCorticosteroids are a potent group of medicines, with many adverse effects, that are widely prescribed in palliative care for both specific and non-specific indications. The aim of this study was to document current patterns of corticosteroid prescribing in New Zealand palliative care settings and to reflect on whether they were in line with international experience.MethodsA retrospective review of inpatient use of corticosteroids was undertaken in a sample of six New Zealand hospices. Data were collected on numbers of patients prescribed corticosteroids, indications for use, choice of agent, doses and dosage changes, duration of course, incidence of adverse effects, method of stopping, use of guidelines, and processes for monitoring and review.ResultsThe case notes of 1179 inpatients were reviewed and 768 patients (65.1%) had received at least one course of corticosteroids. There was a marked consistency in the proportion of patients prescribed corticosteroids among the sample hospices (61-69%). Detailed information was recorded for a sample of 260 patients. Corticosteroids were prescribed most commonly for non-specific reasons (40.4% of prescribing events), followed by neurological (25.3%) and soft tissue infiltration symptoms (14.4%). The agent of choice was dexamethasone with a dose range of 1 mg to 40 mg and a median dose of 8 mg. The median course duration for all corticosteroid prescribing events was 29 days. Abrupt stopping occurred in 72 (23.2%) cases, of these 35 (49%) had been on a course of corticosteroids for more than three weeks. Guidelines were only available in one hospice. Monitoring and review was documented in 135 (52%) of cases, and adverse effects were recorded in 82 (32%); these are likely to be underestimates due to a high level of non-recording.ConclusionsThis New Zealand study showed that corticosteroids are widely prescribed in palliative care, most commonly for non-specific indications. These findings are consistent with the international literature in this area and this large, multi-site study adds weight to the findings and the need for ongoing discussion about the place of these drugs in palliative care.

Medicamentos e Controle de dor: Experiência de um Centro de Referência em Cuidados Paliativos no Brasil

“…Alguns medicamentos possuem múltiplas indicações em cuidados paliativos. Por exemplo: corticosteroides também são prescritos para fadiga, hiporexia e edema tumoral 31,32 ; neurolépticos para delirium 33 e náuseas 34 ; benzodiazepínicos para sedação paliativa 35 e insônia 36 . A análise de sua importância no controle da dor neste estudo foi muito prejudicada.…”

What do young doctors know of Palliative Care; how do they expect the concept to work?

“…remained neutral while the rest disagreed to this statement. Corticosteroids are being prescribed for many non-specific symptoms such as anorexia-cachexia symptoms, nausea, pain and breathlessness (25). Steroids are expected to improve appetite, resolve fatigue and oedematous collections in tissues, thus assisting to improve quality of life (26,27).…”

“…abdominal tumours) etc. have only yielded weak evidence so far (25). Simultaneously, steroids also contribute significantly to the adverse effect burden (25,28,29).…”

“…have only yielded weak evidence so far (25). Simultaneously, steroids also contribute significantly to the adverse effect burden (25,28,29). Therefore, the net benefits over harms of steroids on palliative patients is an area pending further investigations.…”

Dosing of Dexamethasone in Chronic Cancer Pain

“…Denton A et al [10] Retrospective analysis 1179 patients reviewed-768 patients received at least 1 course of steroids. Commonly -non-specific indications-40.4%, neurological (25.3%).…”