Physician-Reported Corticosteroid Therapy Practices in Certified Palliative Care Units in Japan: A Nationwide Survey

Matsuo, Naoki; Morita, Tatsuya; Iwase, Satoru

doi:10.1089/jpm.2011.0534

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…However, there is no clear standard for the dose of corticosteroids for dyspnea, and in clinical practice, the dose is often lower than the usual dose, especially when administered to patients with a short-term survival such as a palliative care unit. The dose of corticosteroid used was approximately the same as the dose used in other Japanese palliative care units [14], and the e cacy was similar to the experienced e cacy rate [4]. Furthermore, in this study, there was no correlation between the initial dose of corticosteroids and their effect [20].…”

Section: Discussionsupporting

confidence: 58%

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Relationship between corticosteroid effect on dyspnea, prognosis prediction, and actual survival

Katayama

Tabata

Mimura³

et al. 2021

Preprint

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Background and Aim: The effect of corticosteroids on dyspnea in patients with advanced cancer is expected to be associated with patient prognosis, though details about this are unclear. Thus, we aimed to investigate the relationship between prognostic indicators, actual survival, and the effect of corticosteroid administration on dyspnea in patients with advanced cancer.Method: We predicted the prognosis using the PaP score (palliative prognostic score) at the time of corticosteroid administration in 56 consecutive patients with cancer who started corticosteroid treatment for dyspnea at a single palliative care unit, and compared it with the actual survival. In addition, we investigated the relationship between the effect of corticosteroids on dyspnea, the prognostic score before administration, the actual survival, and other background factors.Results: The effect of corticosteroids strongly correlated with the actual survival, but not the prognostic score before corticosteroid administration, although it was correlated with prognostic score and actual survival. In addition, the effect of corticosteroids on dyspnea was less associated with other factors.Conclusion: The corticosteroid effect strongly associated with actual survival, but not the prognostic score. It was suggested that the effect of corticosteroids in patients could be predicted by using a more accurate prognosis prediction in the future.

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Section: Discussionsupporting

confidence: 58%

“…We believe that prognostic predictions might re ect the effects of corticosteroids [7], because healthcare professionals believe that corticosteroids are ineffective in patients with cancer considered to have a short survival [14], and its effects generate a good survival [8]. However, as far as we know, no nding clari es these facts.…”

Section: Discussionmentioning

confidence: 99%

Relationship between corticosteroid effect on dyspnea, prognosis prediction, and actual survival

Katayama

Tabata

Mimura³

et al. 2021

Preprint

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“…Internationally, variation exists with large national studies of palliative care providers in both Japan and Sweden selecting betamethasone as the corticosteroid of choice for symptom management of patients with advanced cancer, although neither study specifically addressed painful bone metastases. 19,20 Little evidence exists to directly compare the side effect profiles of these 2 corticosteroids in the palliative care population, and this may represent another area of investigation for clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…We developed an electronic questionnaire using questions adapted from previous surveys of corticosteroid practice patterns of Japanese and Swedish physicians. [19][20][21] The questionnaire consisted of a total of 21 items using a combination of multiple choice, Likert scale, and free text questions. Seven items assessed specific prescribing patterns of corticosteroids; 2 items examined gastroprotective strategies; 11 items assessed provider demographics, including age, sex, race, ethnicity, primary work location, weekly direct clinical care hours, provider credentials, geographic practice region, primary specialty training, and secondary board certification; and 1 item elicited any further comments.…”

Section: Questionnaire Design and Developmentmentioning

confidence: 99%

The Use of Corticosteroids as Adjuvant Therapy for Painful Bone Metastases: A Large Cross-Sectional Survey of Palliative Care Providers

White

Arnold

Bull

et al. 2016

Am J Hosp Palliat Care

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Corticosteroids are commonly prescribed as adjuvant therapy in the treatment of painful bone metastases in patients with limited life expectancy. Dexamethasone is the most commonly selected corticosteroid by American palliative care providers with variation existing among providers regarding dosing schedule, treatment duration, and gastroprotective strategies. Clinical trials comparing a total daily dose of four versus eight milligrams of dexamethasone would be clinically useful to inform evidence-based practice.

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“…1 Steroids are commonly used for fatigue relief in terminally ill patients with cancer. 2,3 Treatment with steroids is also occasionally associated with side effects. 4 These side effects include infection, depression, insomnia, myopathy, and hyperglycemia, all of which may contribute to fatigue.…”

Section: Introductionmentioning

confidence: 99%

Aggravation of Fatigue by Steroid Therapy in Terminally Ill Patients With Cancer

Matsuo¹,

Yomiya

2013

Am J Hosp Palliat Care

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Steroids are commonly used for fatigue relief in terminally ill cancer patients. However, steroid-induced adverse effects including depression, myopathy, and hyperglycemia may contribute to fatigue. We report our experiences with aggravation of fatigue with steroid use in three cases. Case 1 was a 65-year-old man with advanced gastric cancer. He was started on betamethasone (2 mg/d) for fatigue, but the fatigue worsened due to steroid-induced depression. Discontinuation of steroids and initiation of an antidepressant ameliorated the fatigue. Case 2 was a 68-year-old man with advanced lung cancer. He complained of fatigue. Betamethasone (1 mg/d) was started and alleviated the fatigue. However, when the betamethasone dose was increased to 2 mg/d, the fatigue, with muscle weakness and myalgia, worsened due to steroid-induced myopathy. We therefore switched from betamethasone (2 mg/d) to prednisolone (10 mg /d). The fatigue resolved and the patient returned to his previous condition. Case 3 was a 73-year-old man with recurrent bile duct cancer. He also had diabetes mellitus. He developed fatigue, anorexia and fever. We started betamethasone (1.5 mg/d) for these symptoms, but the fatigue and anorexia worsened due to steroid-induced hyperglycemia. Blood glucose rose to 532 mg/dL. Therefore, insulin therapy was started, and the dose of betamethasone was reduced to 0.5 mg/d. His glucose level decreased to less than 320 mg/dL and he recovered from the fatigue while achieving moderate oral intake. In conclusion, the possibility of steroid-induced secondary fatigue in terminally ill cancer patients should be taken into consideration.

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Physician-Reported Corticosteroid Therapy Practices in Certified Palliative Care Units in Japan: A Nationwide Survey

Abstract: The use of corticosteroids is very common in Japanese palliative care units, but physicians reported varying practices and attitudes regarding administration protocols. Future studies are needed to determine the standard treatment protocol for corticosteroid use in the terminally ill.

Cited by 26 publications

References 17 publications

Relationship between corticosteroid effect on dyspnea, prognosis prediction, and actual survival

Relationship between corticosteroid effect on dyspnea, prognosis prediction, and actual survival

The Use of Corticosteroids as Adjuvant Therapy for Painful Bone Metastases: A Large Cross-Sectional Survey of Palliative Care Providers

Aggravation of Fatigue by Steroid Therapy in Terminally Ill Patients With Cancer

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