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Corticosteroids Improve Fatigue, Appetite Loss, and Patient Satisfaction but Not Pain in Opioid-Treated Advanced Cancer Patients, Small Study Shows

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Key Points

  • Methylprednisolone did not improve pain in patients on opioid treatment.
  • Methylprednisolone improved fatigue, appetite loss, and patient satisfaction.

In a small Norwegian study reported in the Journal of Clinical Oncology, Paulsen et al found that methylprednisolone treatment improved fatigue, appetite loss, and patient satisfaction but not pain in patients with advanced cancer receiving opioid treatment for pain.

Study Details

In the study, 49 adult patients with advanced cancer receiving opioids with average pain intensity ≥ 4 on a 0 to 10 (worst) numeric rating scale in the past 24 hours were randomly assigned to receive methylprednisolone at 16 mg twice daily (n = 26) or placebo (n = 23) for 7 days. The primary outcome measure was average pain intensity measured at day 7. Baseline opioid use as oral morphine equivalent was 269.9 mg in the methylprednisolone group and 160.4 mg in the placebo group.

Pain

At day 7, there was no significant difference between the methylprednisolone group and the placebo group in average pain intensity (3.6 vs 3.7, mean difference = −0.08, P = .88) and no difference in change from baseline (−1.16 vs −0.68, P = .50). There was no difference between groups in relative use of opioids (day 7 vs day 0), with the relative dose increasing by a similar magnitude in both (1.19 vs 1.20, P = .95).

Secondary Outcomes

As measured by the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire C30 (0–100 scale), the methylprednisolone group had statistically and clinically significant improvements in fatigue (mean change = 17 vs −3 points, P = .003) and appetite loss (mean change = 24 vs −2 points, P = .003). There was also a statistically and clinically significant improvement in patient satisfaction (0–10 scale) in the methylprednisolone group (5.4 vs 2.0 points, P < .001).

There were no differences in adverse events between the groups.

The investigators concluded, “[Methylprednisolone] 32 mg daily did not provide additional analgesia in patients with cancer receiving opioids, but it improved fatigue, appetite loss, and patient satisfaction. Clinical benefit beyond a short-term effect must be examined in a future study.”

Ørnulf Paulsen, MD, of Telemark Hospital Trust, Skien, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by grants from the Telemark Hospital Trust and South-Eastern Norway Regional Health Authority. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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