Routine Use of Dexamethasone Not Recommended for Dyspnea in Cancer

A review on the use of corticosteroids for dyspnea in patients with cancer is recommending against routine use of dexamethasone for dyspnea in these patients. These findings were published in Current Opinion in Supportive & Palliative Care.

Dyspnea is a common and highly distressing symptom affecting patients with cancer. Corticosteroids can be used to treat dyspnea; however, there is a lack of high-quality studies to guide clinical practice for prescribing corticosteroids to patients with cancer.

The available evidence regarding corticosteroid use for the treatment of dyspnea in patients with cancer comes from observational studies with small sample sizes and from clinical trials, in which dyspnea was often a secondary outcome. In general, observational studies supported the selective use of corticosteroids; however, the randomized trials had conflicting results.

In 3 randomized trials that included dyspnea as a secondary outcome, 1 reported a significant improvement in symptoms at day 10 of dexamethasone treatment, 1 reported a nonsignificant improvement in symptoms at days 8 and 15 of dexamethasone treatment, and the third reported no improvement in symptoms after 2 weeks of treatment with methylprednisolone acetate.

Two clinical trials had dyspnea as a primary outcome. The larger of the 2 trials reported no significant difference from placebo in dyspnea numeric rating scale scores at day 7 of dexamethasone treatment relative to baseline (P =.48). This trial reported that dexamethasone recipients had higher instances of grade 3 or higher adverse effects, in which 28% of dexamethasone recipients were hospitalized for adverse effects compared with 7% of placebo recipients.

“We recommend against the routine use of high-dose dexamethasone in unselected patients and cautiously support the selective use of corticosteroids for certain conditions,” the review authors concluded.

Reference

Hui D, Yennurajalingam S. The role of corticosteroids in the palliation of dyspnea in cancer patients: an evidence-based review. Curr Opin Support Palliat Care. Published online September 29, 2023. doi:10.1097/SPC.0000000000000677