Key notes on symptom control issues in Palliative Care

Use of Steroids in Palliative Care

Steroids are frequently used in palliative care to help with symptom control. The risks and benefits to the patient should always be considered before they are started, but in patients with a limited prognosis, they can help considerably in improving quality of life.

In all cases, the dose should be titrated down as quickly as possible, depending on the patient’s condition, to the lowest dose that controls symptoms. All patients at risk of GI side effects should have either a proton pump inhibitor or misoprostol prescribed along with the steroid.

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  In oncological emergencies – spinal cord compression, superior vena caval obstruction (SVCO). Give 12mg dexamethasone in a single dose before admitting to hospital.
  

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  To reduce inflammation associated with the disease process or treatment (non-steroidal anti-inflammatory drugs may have a similar role). Starting dose of dexamethasone is 12mg in a single daily dose.
  

Liver capsular pain

Lymphangitis

Post radiotherapy

Brain tumours causing neurological symptoms or headache associated with raised intracranial pressure

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  As an anti-emetic. Dose of dexamethasone is usually between 4 and 8mg daily for a finite number of days.
  

Pre and post chemotherapy anti-emetic regimens

Radiotherapy. Anti-emetic regimens where part of the bowel is irradiated

In bowel obstruction

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  As an appetite stimulant. Starting dose of dexamethasone is usually between 4 and 6mg daily. They should be stopped after two weeks if there is no improvement.
  

Temporarily increases appetite in some individuals.

Patients may experience an increased sense of well being. This may be due to better nutrition or a direct central effect of the steroids.

Side effects are common. The key ones to look out for are:

Oral and oesophageal thrush

Gastro-intestinal irritation or bleeding

Agitation and poor sleep. Give steroid dose in the morning.

Muscle wasting especially the thighs and upper arms.

Skin fragility leading to increased risk of bedsores, wound break down.

Vaginal or penile thrush.