Corticosteroids in terminal cancer--a prospective analysis of current practice

Over half of a group of 373 inpatients with advanced malignant disease were treated with corticosteroids for a variety of reasons. They received either prednisolone or dexamethasone, or replacement therapy with cortisone acetate. Forty percent of those receiving corticosteroids benefited from them. A higher response rate was seen when corticosteroids were prescribed for nerve compression pain, for raised intracranial pressure, and when used in conjunction with chemotherapy. No significant difference in efficacy was noted between the 2 drugs. The results, however, suggest that with a larger sample, dexamethasone would have been shown to be significantly better than prednisolone in the management of nerve compression pain. The incidence of side effects was broadly similar with dexamethasone and prednisolone. The most common side effect was oral candidosis and there was a highly significant relationship between the use of corticosteroids and the prescription of nystatin suspension. Dexamethasone was more likely than prednisolone to cause oro-pharyngeal candidosis. Dexamethasone was also associated with significantly more cases of psychological disturbance and hyperactivity. On the other hand, dexamethasone seems less likely to cause oedema, weight gain and dyspepsia. Corticosteroids were withdrawn because of side effects in only 11 patients (5%)--6 were receiving dexamethasone and 5 prednisolone. Dexamethasone has been adopted as the standard corticosteroid for terminal cancer patients at Sir Michael Sobell House.