Dexamethasone Use in Inpatient Palliative Care

Abstract

Aim To describe the prescribing patterns of dexamethasone in a cohort of palliative care inpatients. Method Data were collected from a consecutive sample of patients admitted to 2 palliative care units over an 8 week period. Data on dexamethasone use was also collected, i.e. indication for use, dosages, concurrent medications, adverse effects, blood glucose levels and reasons for changes in dose. Results 359 patients were admitted during the recruitment period and 185 (52%) were prescribed dexamethasone. 37 (20%) patients were prescribed dexamethasone for specific indications, such as cerebral disease, spinal cord compression and bowel obstruction. The majority of dexamethasone was prescribed for non‐specific indications: poor appetite, nausea, and poor wellbeing. A range of doses was prescribed for each indication and during their inpatient stay most patients (65%) had their dose reduced. Adverse effects were commonly reported; 117 (63%) patients experienced adverse effects attributable to dexamethasone. Conclusion Dexamethasone use is widespread in palliative care for a myriad of indications.

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

“…The most frequent prescribing indication was non-specific (40.4%), again this is in line with international experience if a broad definition of non-specific is used [4,14]. While this is a notable result, given that there is relatively little published evidence to support the use of corticosteroids for non-specific reasons [48], it has to be interpreted with some caution because of varying definitions of non-specific indications in the literature.…”

“…They are commonly prescribed for patients in palliative care for both specific and non-specific indications [4-9]. Corticosteroids are potent medicines with frequent adverse effects and while the intent is to achieve beneficial results for the patient, the consequences of long-term use may counteract this objective [10].…”

Corticosteroids in palliative care - perspectives of clinicians involved in prescribing: a qualitative study

“…A strength of this mixed-methods approach was that interviewees were able to comment on the summary data from the previous study which showed how prescribing practice at their hospice compared to others in the sample. To the best of our knowledge, this is the first qualitative study of its kind, although there have been a number of quantitative studies which have documented corticosteroid prescribing practices [ 1 – 5 , 7 , 9 – 12 ]. The interviews with clinicians yielded rich insights into the place of these drugs in palliative care and the main influences on their prescribing.…”

“…Corticosteroids are a potent group of medicines which have been used in palliative care since the late 1950s to alleviate both specific and non-specific debilitating symptoms [ 1 – 5 ]. The proportion of palliative care patients prescribed corticosteroids has been reported as ranging from 32% to 80%, with a median of about 60% [ 1 – 4 , 6 – 13 ]. In a recent New Zealand study of corticosteroid prescribing in palliative care, we observed that 65% of patients received at least one course of corticosteroids and there was a marked consistency in prescribing frequency across the six sample hospices (range: 61-69%) [ 14 ].…”

“…The adverse effects of corticosteroids are well-known, as are the challenges associated with choice of agent, dose, duration, route, monitoring and abrupt cessation [ 1 , 3 , 8 , 12 , 13 , 20 – 22 , 26 – 30 ]. Clinicians must balance the potential benefits and harm associated with these potent drugs and guidelines have been developed to assist decision-making and curb the potential for inappropriate prescribing [ 8 , 31 ].…”