Dexamethasone Eases End-Of-Life Cancer-Related Fatigue

CypressCynthia
CypressCynthia Member Posts: 4,014 Member

Interesting article: http://www.practiceupdate.com/Explore/News/?id=2250 about adding oral dexamethasone 4 mg twice daily to improve quality of life at the end.

Comments

  • SIROD
    SIROD Member Posts: 2,194 Member
    Unable to Read Article

    Couldn't read it as the web page needs a username and password.  Perhaps just post the story?

     

    Doris

  • Bella Luna
    Bella Luna Member Posts: 1,578 Member
    Sounds Familiar

    Interesting... I am pretty sure that was one of the pills I had to take the night before my chemo days.  Thanks for the info.  Hugs to you.

  • CypressCynthia
    CypressCynthia Member Posts: 4,014 Member
    SIROD said:

    Unable to Read Article

    Couldn't read it as the web page needs a username and password.  Perhaps just post the story?

     

    Doris

    Sorry!  Try this

    Sorry!  Try this one:

    http://www.oncologypractice.com/oncologyreport/news/top-news/single-view/dexamethasone-eases-end-of-life-cancer-related-fatigue/0efa2f6c1995c1f2631f15158cc523a9.html

    Dexamethasone eases end-of-life cancer-related fatigue



    NEW ORLEANS – Dexamethasone was more effective than was placebo in relieving cancer-related fatigue in a double-blind randomized trial of patients with advanced cancer.

    After 14 days of treatment, scores on the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue subscale improved by nearly 6 points in the dexamethasone group (9.0 vs. 3.1; P = .008).

     

    Patrice Wendling/IMNG Medical Media


    Dr. Sriram Yennu

     

    "[Treatment] duration is very important in our patient population because when they are referred to us, it’s very late. They typically have a survival of just 28 to 7 days," Dr. Sriram Yennu said at the annual meeting of the American Academy of Hospice and Palliative Medicine.

    Although 20%-50% of palliative care patients receive some form of corticosteroid, no steroid study to date has used cancer-related fatigue (CRF) as a primary outcome or assessed CRF with a validated outcome measure, he said. Fatigue is ubiquitous, however, contributing up to one-third of symptom distress in patients with advanced cancer.

    The study enrolled 132 outpatients with a life expectancy of at least 4 weeks with three or more cancer-related symptoms (fatigue, pain, nausea, loss of appetite, depression, anxiety, or sleep disturbance), and randomly assigned them to oral dexamethasone 4 mg twice daily or placebo for 14 days.

    The most common diagnosis was head and neck/lung cancer in 45 patients, followed by gastrointestinal cancer in 39, breast cancer in 13, and genitourinary in 10. Median patient age was 60; 81 patients were white, and the average FACIT fatigue score was 19.6, where 52 denotes no fatigue and 0 is severe fatigue.

    Among 84 evaluable patients, total scores on FACIT favored the dexamethasone group (18.16 vs. 7.87; P = .03), as did scores on its physical subscale (5.25 vs. 1.32; P = .002), said Dr. Yennu of the department of palliative care and rehabilitation medicine, University of Texas MD Anderson Cancer Center, Houston.

    Scores on the physical domain of the Edmonton Symptom Assessment Scale (ESAS) were better in the dexamethasone group than in the placebo group (–10.15 vs. –5.39; P = .04), according to the study, which earned Dr. Yennu a young investigator award.

    Notably, scores were similar between the dexamethasone and placebo groups on the emotional subscale of FACIT (1.85 vs. 1.18; P = .49) and the ESAS psychological subscale (–1.48 vs. –2.08; P = .76). The emotional domain of the FACIT-F is measured by six items using a 0-4 scale where 0 is "not at all" and 4 includes statements like "I am losing hope in the fight against my illness." The finding suggests that the improvement in fatigue was likely not just a euphoric effect, as observed before in other steroid trials, Dr. Yennu said.

    He expressed concern that corticosteroid use would increase toxicity, particularly insomnia, but no significant differences were observed between the dexamethasone and placebo groups regarding insomnia (3 vs. 4), overall adverse events (41 vs. 44) or serious adverse events (17 vs. 11).

    Larger, long-term safety and efficacy studies are needed to address steroid dose and duration, and whether dexamethasone should be coupled with interventions targeting the psychological domain, he said. A 3-point difference in the FACIT is considered clinically important, but research in press in the Journal of Clinical Oncology, by Dr. Yennu and his colleagues, suggests a 10-point difference is more meaningful.