Miller, S., McNutt, L., McCann, M.A., & McCorry, N. (2014). Use of corticosteroids for anorexia in palliative medicine: A systematic review. Journal of Palliative Medicine, 17, 482–485. 

DOI Link

Purpose

STUDY PURPOSE: To identify the evidence for the use of corticosteroids and the most safe and effective dosing regimen for the management of anorexia in palliative care patients
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, CINAHL
 
KEYWORDS: Adrenal cortex hormones, corticosteroids, dexamethasone, prednisolone, hydrocortisone, AND anorexia, appetite, appetite stimulants, weight loss, cachexia, AND palliative, palliative care
 
INCLUSION CRITERIA: Original research articles in English; subjects over 18 years of age; studies including corticosteroids as an intervention for anorexia with separate outcome data identifiable for anorexia.
 
EXCLUSION CRITERIA: None listed

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Eighty-nine articles were identified in search; 33 articles were excluded either because steroids were not used to treat anorexia or the outcome for anorexia could not be identified separately from other symptoms. Five case reports, four letters, four surveys of physician opinions, and 33 review articles were excluded because they were not original studies that evaluated the efficacy of steroids. One study was excluded since it only included patients with potentially curative disease. One study was excluded because the article or its abstract could not be obtained. This left eight remaining articles that were included in this review.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Seven of the studies were randomized trials and one was a prospective survey of steroid prescribing. Size of samples varied. Specific steroids used varied as did the route of administration of the steroids. Duration of therapy was not consistent between studies. Multiple variables made it difficult for the authors to draw conclusions.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 8
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,356
  • SAMPLE RANGE ACROSS STUDIES = 40–496 patients 
  • KEY SAMPLE CHARACTERISTICS: Most study participants had advanced cancer, all were in palliative care, and all were adults over the age of 18 years. Various corticosteroids were used in studies including dexamethasone, methylprednisolone, and betamethasone. Range of doses (dexamethasone-equivalent doses) ranged from 3–25 mg per day via various routes including oral and IV. One study included the use of metoclopramide, one included the use of megestrol, and four studies included use of a placebo.

Phase of Care and Clinical Applications

PHASE OF CARE: End-of-life care
 
APPLICATIONS: Palliative care

Results

All studies showed an improvement in appetite with the specific steroid used in the study. Side effects were an issue for continued treatment and led to attrition of rates between 16% and 63%. Improvement in appetite was shown to continue through up to eight weeks of therapy. Side effects were a common cause of attrition.

Conclusions

Corticosteroids can be beneficial in treating anorexia in patients with malignancies who are in the palliative care setting. There is inadequate data to recommend a specific steroid over another or a specific dose of the steroid for the management of anorexia.

Limitations

Various steroids, various routes of administration, and various doses were used, making it difficult to make any conclusions. Steroids are associated with significant side effects including gastrointestinal bleeding, oral candidiasis, and proximal myopathy.  

Nursing Implications

Anorexia is a significant problem in individuals with cancer, especially in certain malignancies and at the end of life. Nurses need to be aware of potential treatment options and side effects of these treatments to enhance patients' quality of life.

Legacy ID

4741