Corticosteroids for the management of cancer-related pain in adults

Haywood, Alison; Good, Phillip; Khan, Sohil; Leupp, Aurelia; Jenkins-Marsh, Sue; Rickett, Kirsty; Hardy, Janet

doi:10.1002/14651858.cd010756.pub2

Cited by 60 publications

(39 citation statements)

References 49 publications

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“…If the pain is not sufficiently controlled a weak opioid can then be introduced, and subsequently a strong opioid. Steroids have been shown to reduce cancer-related pain [103]. For neuropathic pain, amitriptyline, sodium valproate or gabapentin may be administered [104].…”

Section: Palliation: Pain Relief Nutrition and Jaundicementioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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Section: Palliation: Pain Relief Nutrition and Jaundicementioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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“…Corticosteroids are commonly used in management of cancer pain however there is limited quality data supporting their efficacy for this purpose (1,2). A recent Cochrane systematic review in 2015 evaluated the efficacy of corticosteroids in treating cancer-related pain in adults (3). In this review there were fifteen studies that met the inclusion criteria, with a total of 1926 participants enrolled.…”

Section: Corticosteroids As Co-analgesics With Opioids For Cancer Relmentioning

confidence: 99%

Corticosteroids as Co-analgesics With Opioids for Cancer-Related Pain: A Feasibility Study

Ashar

Hardy

Good

et al. 2017

Journal of Pain and Symptom Management

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“…With regard to the treatment of pain, a randomized controlled trial found no analgesic effect of corticosteroids in cancer patients taking opioids [17], whereas two studies have showed an analgesic effect [19], or temporarily increased pain control [16]. A meta-analysis in a recently published Cochrane review concluded that corticosteroids could provide a mean reduction of pain intensity of 0.84 on a numeric rating scale (NRS 0–10) (confidence interval, (CI) -1.38 to -0.3) after one week of treatment [20]. The mechanisms of action are not well defined, but are thought to be mediated by their anti-inflammatory effects.…”

Section: Introductionmentioning

confidence: 99%

The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer

et al. 2017

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BackgroundSystemic inflammation is associated with reduced quality of life and increased symptoms in patients with advanced cancer. The aims of this study were to examine the relationships between inflammatory biomarkers and the Patient Reported Outcome Measures (PROMs) of pain, appetite and fatigue; and to explore whether levels of baseline biomarkers were associated with changes in these PROMs following treatment with corticosteroids.Material and methodsAn exploratory analysis was done on a trial examining the analgesic properties of corticosteroids in patients with advanced cancer. Inclusion criteria were: >18 years, taking opioids for moderate or severe cancer pain; pain ≥4 (numerical rating scale 0–10). Serum was extracted and levels of inflammatory biomarkers were assessed. PROMs of pain, appetite and fatigue were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The relationships between PROMs and inflammatory biomarkers were examined using Spearman Rho-Rank and multiple regression analysis.ResultsData were available on 49 patients. Levels of sTNF-r1, IL-6, IL-18, MIF, MCP-1, TGF-β1, IL-1ra, and C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were elevated; IL-1β, IL-2, IL-4, IL-8, IL-10, IL-12(p70), interferon-γ, MIP-1α, and TNF-α were below the level of detection. The following correlations were observed: appetite and IL-6 and CRP; fatigue and IL-1ra (rs: 0.38–0.41, p< .01). There was no association between pretreatment biomarkers and effect from corticosteroid treatment.ConclusionIn patients with advanced cancer and pain, some pro-inflammatory cytokines were related to appetite and fatigue. Inflammatory biomarkers were not associated with pain or with the efficacy of corticosteroid therapy. Further research examining the attenuation of the systemic inflammatory response and possible effects on symptoms would be of interest.

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Corticosteroids for the management of cancer-related pain in adults

Cited by 60 publications

References 49 publications

Pancreatic Cancer: Yesterday, Today and Tomorrow

Pancreatic Cancer: Yesterday, Today and Tomorrow

Corticosteroids as Co-analgesics With Opioids for Cancer-Related Pain: A Feasibility Study

The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer

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