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

White, Patrick; Arnold, Robert M.; Bull, Janet; Cicero, Brandon D.

doi:10.1177/1049909116683720

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…Moreover, they are used as adjuvant therapy for painful bone metastases. According to a recent survey of palliative care providers in US, dexamethasone is the most commonly prescribed corticosteroid [41]. The rate of pain relief ranges between 30% and 70%, however their use is particularly useful for reducing pain flares during radiotherapy for patients with bone metastases [42].…”

Section: Corticosteroidsmentioning

confidence: 99%

Pain Management in Patients with Multiple Myeloma: An Update

Coluzzi

Rolke

Mercadante

2019

Cancers

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Most patients with multiple myeloma (MM) suffer from chronic pain at every stage of the natural disease process. This review focuses on the most common causes of chronic pain in MM patients: (1) pain from myeloma bone disease (MBD); (2) chemotherapy-induced peripheral neuropathy as a possible consequence of proteasome inhibitor therapy (i.e., bortezomib-induced); (3) post-herpetic neuralgia as a possible complication of varicella zoster virus reactivation because of post-transplantation immunodepression; and (4) pain in cancer survivors, with increasing numbers due to the success of antiblastic treatments, which have significantly improved overall survival and quality of life. In this review, non-pain specialists will find an overview including a detailed description of physiopathological mechanisms underlying central sensitization and pain chronification in bone pain, the rationale for the correct use of analgesics and invasive techniques in different pain syndromes, and the most recent recommendations published on these topics. The ultimate target of this review was to underlie that different types of pain can be observed in MM patients, and highlight that only after an accurate pain assessment, clinical examination, and pain classification, can pain be safely and effectively addressed by selecting the right analgesic option for the right patient.

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Section: Corticosteroidsmentioning

confidence: 99%

Pain Management in Patients with Multiple Myeloma: An Update

Coluzzi

Rolke

Mercadante

2019

Cancers

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“…Corticosteroid treatment is usually tapered over two weeks using the ones with minimal mineralocorticoid effects. One of the most prescribed corticosteroids is dexamethasone due to its long half-life and the absence of mineralocorticoid properties, with minor fluid retention ( 55 ).…”

Section: Resultsmentioning

confidence: 99%

A Multimodal Clinical Approach for the Treatment of Bone Metastases in Solid Tumors

et al. 2022

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Context: Bone metastasis (BM) is a frequent complication of cancer, representing the third most common site of secondary spread in solid cancers behind the lung and liver. Bone metastasis is found in up to 90% of prostate and breast cancer patients. They can cause significant complications, such as pathological fractures and paralysis of the spine, which decrease daily functioning and quality of life (QoL) and worsen prognosis. The growing life expectancy of cancer patients due to improvements in systemic therapies may further increase BM's eventuality and clinical burden in cancer patients. Evidence Acquisition: Four physicians from five different specialties were interviewed and resumed the most relevant literature of the last 20 years focusing on pain treatment in BM patients. Results: Treatment for BM ideally involves various types of specialists and assessments. The disease status and patient background should be considered, requiring holistic care and expertise from various medical specialties. Conclusions: Interventional, nuclear medicine, radiotherapy, and mini-invasive techniques can be safe and effective for relieving pain and modifying health-related QoL in BM patients.

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“…Despite this relatively weak evidence, in a large survey of American palliative care providers, 98% of responders reported having prescribed corticosteroids as adjuvant pain therapy. 33 A recent review 34 has confirmed the finding that dexamethasone reduces pain flare post radiotherapy. Don'ts.…”

Section: Symptom Controlmentioning

confidence: 87%

Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer

et al. 2021

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Background: It would be unusual for a patient with advanced cancer not to be prescribed corticosteroids at some stage of their disease course for a variety of specific and non-specific indications. Aim: The aim of this practice review was to provide a pragmatic overview of the evidence supporting current practice and to identify areas in which further research is indicated. Design: A ‘state-of-the-art’ review approach was used to examine the evidence supporting the use of corticosteroids for the management of cancer-related complications and in symptom control, in the context of known risks and harms to inform quality use of this medicine. We developed ‘Do’, ‘Do not’, and ‘Don’t know’ recommendations based on current literature and identified areas for future investigation and research. Data sources: We searched MEDLINE, EMBASE and the Cochrane library from inception to 14th October 2020. Our initial search limited to reviews, reviews of reviews, randomised controlled trials (RCTs) and controlled trials was supplemented by supporting literature as appropriate. Results: Evidence to support common practice in the use of corticosteroids is lacking for most indications. This is in the context of strong evidence for the potential for significant toxicity and poor quality use of medicine. Conclusion: Guidelines recommending the widespread use of corticosteroids should acknowledge the poor evidence base supporting much current dogma. Quality research is essential not only to define the role of corticosteroids in this context but to ensure good prescribing practice.

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

Cited by 16 publications

References 31 publications

Pain Management in Patients with Multiple Myeloma: An Update

Pain Management in Patients with Multiple Myeloma: An Update

A Multimodal Clinical Approach for the Treatment of Bone Metastases in Solid Tumors

Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer

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