Corticosteroids in Cancer Pain Management
Corticosteroids in Cancer Pain Management
Hello. I'm Bret Stetka, editorial director at Medscape. Welcome to the F1000 Practice-Changing Minute, where we report commentaries from the Faculty of 1000 on highly rated studies that may change clinical practice.
Today's commentary covers the study "Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids: A Randomized, Placebo-Controlled, Double-Blind Trial." Our commentator has given this study a ranking of "Changes Clinical Practice," with the conclusion that corticosteroids should be administered for cancer-related fatigue, not pain.
Today's F1000 commentary comes from Dr Mellar Davis, professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr Davis wrote:
Corticosteroids have been recommended as adjuvant analgesics for cancer pain, particularly for bone pain. Yet there are few, if any, randomized trials except the one conducted by Dr Paulsen and colleagues. In this well-conducted and adequately powered study, the primary outcome of pain was not improved with 16 mg of methylprednisolone twice daily for 7 days relative to placebo. But also what was of interest and a confirmation of a previous study was the improvement in fatigue as well as appetite. The findings from this study confirm the benefits of corticosteroids in managing cancer fatigue as published by the group from M.D. Anderson. Corticosteroid side effects included restlessness and sleeplessness. If the trial had been extended, other neuropsychiatric or endocrine side effects would likely have been observed. Criticisms of this study could include the short duration of the study and a small dose of steroid. Potentially, individuals with fatigue may respond at lower doses than those in pain. It is important that clinicians use corticosteroids in the right way for those with advanced cancer. They are often given for multiple reasons for which there is little good evidence (such as pain). In my estimation, as this is the second randomized trial of corticosteroids versus placebo to demonstrate benefits in reducing cancer fatigue, this should influence our practice; corticosteroids should be given for fatigue and not for pain.
This concludes today's commentary from Dr Davis. For the F1000 Practice-Changing Minute, I am Bret Stetka. Thank you for listening.
Hello. I'm Bret Stetka, editorial director at Medscape. Welcome to the F1000 Practice-Changing Minute, where we report commentaries from the Faculty of 1000 on highly rated studies that may change clinical practice.
Today's commentary covers the study "Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids: A Randomized, Placebo-Controlled, Double-Blind Trial." Our commentator has given this study a ranking of "Changes Clinical Practice," with the conclusion that corticosteroids should be administered for cancer-related fatigue, not pain.
Today's F1000 commentary comes from Dr Mellar Davis, professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr Davis wrote:
Corticosteroids have been recommended as adjuvant analgesics for cancer pain, particularly for bone pain. Yet there are few, if any, randomized trials except the one conducted by Dr Paulsen and colleagues. In this well-conducted and adequately powered study, the primary outcome of pain was not improved with 16 mg of methylprednisolone twice daily for 7 days relative to placebo. But also what was of interest and a confirmation of a previous study was the improvement in fatigue as well as appetite. The findings from this study confirm the benefits of corticosteroids in managing cancer fatigue as published by the group from M.D. Anderson. Corticosteroid side effects included restlessness and sleeplessness. If the trial had been extended, other neuropsychiatric or endocrine side effects would likely have been observed. Criticisms of this study could include the short duration of the study and a small dose of steroid. Potentially, individuals with fatigue may respond at lower doses than those in pain. It is important that clinicians use corticosteroids in the right way for those with advanced cancer. They are often given for multiple reasons for which there is little good evidence (such as pain). In my estimation, as this is the second randomized trial of corticosteroids versus placebo to demonstrate benefits in reducing cancer fatigue, this should influence our practice; corticosteroids should be given for fatigue and not for pain.
This concludes today's commentary from Dr Davis. For the F1000 Practice-Changing Minute, I am Bret Stetka. Thank you for listening.