Blogger: Ørnulf Paulsen
Ørnulf Paulsen is a PhD student at European Palliative Care Research Centre, NTNU, and Senior Consultant in palliative medicine at Telemark Hospital
Until now, clinicians have assumed that corticosteroids effectively relieve pain in cancer patients. A new study shows that this is not the case.
The results from our study have recently been published in the acknowledged Journal of Clinical Oncology.
Placebo shows same effect
Corticosteroids are widely used for the most advanced cancer patients, and pain treatment is one of the indications. The pain relieving effect, however, has never been documented in research results. Our study showed that the drug had no pain relieving effect for the cancer patients who participated in the study.
The patients received basic pain treatment with paracetamol and morphine. In the study, the patients in addition received cortisone (Medrol®, methylprednisolone) or placebo. After one week of treatment, the group receiving cortisone did not achieve better pain relief than the control group.
Corticosteroids have side effects
Cortisone is a natural hormone produced in the adrenal cortex. Synthetic cortisone is a group of drugs often called steroids or corticosteroids. The drug suppresses the body’s immune responses and has an anti-inflammatory effect. It is used in the treatment of several diseases, such as rheumatic diseases, asthma, ulcerous colitis and Crohn’s disease.
Treatment with corticosteroids causes side effects. Diabetes, skin changes, psychological changes, anxiety and muscle weakness are examples of side effects which present themselves after long term usage or high doses. Advanced cancer patients experience many symptoms, and it is of vital importance to make sure that treatment given has the desired effect and does not cause unnecessary side effects. Corticosteroids have been used in cancer treatment for decades. The drugs may have an effect in many symptoms and can increase quality of life. This might be one of the reasons for the extensive usage.
Treatment practice needs to change
Pain is the most common symptom in cancer patients. Our study shows, however, that use of corticosteroids as a general pain-reliever is not advisable. These results point to a need for change in treatment practice. Simultaneously, the study indicates less fatigue and better appetite for patients treated with corticosteroids. Both fatigue and loss of appetite are troublesome symptoms for advanced cancer patients.
At the Hospital in Telemark, where I am a senior consultant in Palliative medicine, we have changed our practice. Corticosteroids are no longer used as a general pain-reliever, but instead used controlled, targeted and in shorter courses when we know it will have the desired effect.
Corticosteroids have previously been recommended for treatment of cancer pain in several guidelines. The European Association for Palliative Care (EAPC) is currently revising the European guidelines for pain treatment. On my recommendation, the recommendations for use of corticosteroids as pain treatment will be changed as a consequence of new research, including this study.
This study and its results will help improve everyday life for cancer patients with advanced and life limiting disease.
The research article is available online from the Journal of Clinical Oncology: Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids: A Randomized, Placebo-Controlled, Double-Blind Trial
The study was conducted at European Palliative Care Research Centre (PRC), NTNU, and coordinated by Telemark Hospital in Skien. In addition Department of palliative care at St. Olavs Hospital, Trondheim University Hospital as well as the cancer departments of Haraldsplass Deaconal Hospital (Bergen), Hospital of Southern Norway (Kristiansand) and Oslo University Hospital, Ullevål contributed to the study.