Take-Home Pearl: Dexamethasone (steroid) can significantly improve cancer-related fatigue among those with advanced cancer. It also improves lack of appetite, but not psychological distress.
Background: Fatigue is the most common cancer-related symptoms among those with advanced disease. While there is data to support the use of steroids, only about 1/3 oncologists prescribe steroids.
Study Design: Prospective, randomized double-blind, placebo-controlled multi-institutional study. 132 patients with advanced cancer had at least 3 symptoms in the prior 24 hours (pain, fatigue, nausea with lack of appetite or with significant weight loss, sleep disturbance, depression). All had hemoglobin levels of at least 9, neutrophils at least 750, and a life expectancy of at least 4 weeks.
- Randomization: Dexamethasone 4 mg twice daily for 14 days or placebo.
Results: Compared with placebo, dexamethasone produces a rapid and significant improvement in cancer-related fatigue and quality of life, with no significant increase in adverse events among patients with advanced cancer.
My Take: Steroids typically provide only temporary relief. Thus, we don’t fully understand their use for chronic fatigue. Long-term steroid use is not without toxicity. Still, this study provides more incentive to use steroids for short-term pain relief among those with a limited life expectancy. I’m Dr. Michael Hunter.
Reference: Yennurajalingam S et al. J Clinical Oncology 2013;31 (September 1): 3076-3082.