Corticosteroids in Hospice and Palliative Care (Reading & Sharing)

Corticosteroids may be used to treat a variety of conditions and symptoms in the palliative care patient, including cerebral edema, spinal cord compression, pain, nausea/vomiting, malignant bowel obstruction, fatigue, and loss of appetite.

***Tumor edema is a common complication of primary or metastatic brain tumors and may cause significant symptoms of elevated intracranial pressure, such as headache, altered mental status, and seizures. Tumor edema may be secondary to tumor cell death, tumor growth, or related to treatment (for example, postoperative edema). The mainstay of therapy for brain tumor edema is systemic corticosteroids, most commonly dexamethasone. ***

Although steroids can be very effective, they are associated with frequent and significant adverse effects, particularly with prolonged used. Common effects of even short-term steroid use include disturbed sleep, hyperglycemia, delirium or agitation, fluid retention, gastric ulceration, and increased susceptibility to infection. Prolonged steroid use may lead to osteoporosis, myopathy, and cataracts.

Corticosteroids such as prednisone and methylprednisolone are associated with important adverse cardiovascular effects such as sodium and fluid retention, expanded extracellular fluid volume, hypokalemia, and increased BP (possibly associated with an increase in peripheral vascular resistance), all of which increase the risk of cardiac decompensation. However, dexamethasone has some mineralocorticoid activity with less risk of sodium retention, which may make it a safer alternative than some of the other drugs in this class. Additional concerns with corticosteroids include the risk of interaction with anticoagulants and gastrointestinal side effects in the patient taking aspirin.

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