Corticosteroids—The Double-Edged Sword of Palliative Care
Jay Vanston, MD HMDC FAAHPM
Patients with advanced cancer suffer from a host of physical and psychological symptoms including pain, fatigue, anorexia, cachexia, nausea, and depression.1 Many of these symptoms are thought to be caused by the generation of inflammatory cytokines and proteins created because of the carcinoma itself or as a result of cytotoxic therapies.2 The formation of these inflammatory cytokines and proteins begins with the breakdown of phospholipids to arachidonic acid by phospholipase A. Arachidonic acid is further broken down to prostaglandins and leukotrienes through the action of cyclooxygenase and lipoxygenase respectively. By inhibiting phospholipase A, corticosteroids effectively inhibit this inflammatory cascade.
Corticosteroids are among the most commonly used medications in palliative care. Clear indications include management of spinal cord compression, raised intracranial pressure, and bowel obstruction. Although the evidence is less robust, steroids are very frequently used for pain, anorexia, cachexia, nausea/ vomiting, and fatigue.2,3,4,5 In addition to their effect on the modulation of proinflammatory mediators, steroids are also postulated to benefit the individual through the reduction of peritumor edema, modulation of the adrenergic activity in the dorsal horn of the spinal cord, lessening of fatigue, and the effect of euphoria.1