Corticosteroids for the management of cancer-related pain in adults (Review)

Haywood, Alison, Good, Phillip, Khan, Sohil, Leupp, Aurelia, Jenkins-Marsh, Sue, Rickett, Kirsty and Hardy, Janet R. (2015) Corticosteroids for the management of cancer-related pain in adults (Review). Cochrane Database of Systematic Reviews, 4 4: Art. No.: CD010756-Art. No.: CD010756. doi:10.1002/14651858.CD010756.pub2

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Author Haywood, Alison
Good, Phillip
Khan, Sohil
Leupp, Aurelia
Jenkins-Marsh, Sue
Rickett, Kirsty
Hardy, Janet R.
Title Corticosteroids for the management of cancer-related pain in adults (Review)
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1465-1858
Publication date 2015-04-28
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD010756.pub2
Open Access Status File (Author Post-print)
Volume 4
Issue 4
Start page Art. No.: CD010756
End page Art. No.: CD010756
Total pages 45
Place of publication Oxford, United Kingdom
Publisher John Wiley and Sons
Collection year 2016
Language eng
Formatted abstract
Background
One of the most feared symptoms associated with cancer is pain. Opioids remain the mainstay of pain treatment but corticosteroids are often used concurrently as co- or adjuvant analgesics. Due to their anti-inflammatory mechanism of action, corticosteroids are said to provide effective analgesia for pain associated with inflammation and in the management of cancer-related complications such as brain metastasis and spinal cord compression. However, corticosteroids have a wide range of adverse effects that are dose and time dependent.

Objectives
To evaluate the efficacy of corticosteroids in treating cancer-related pain in adults.  Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 4),MEDLINE (OVID) (1966 to 29 September 2014), EMBASE (OVID) (1970 to 29 September 2014), CINAHL (1982 to 29 September 2014), Science Citation Index (Web of Science) (1899 to 29 September 2014) and Conference Proceedings Citation Index - Science (Web of Science) (1990 to 29 September 2014).

Selection criteria
Any randomised or prospective controlled trial that included patients over 18 years with cancer-related pain were eligible for the review. Corticosteroids were compared to placebo or usual treatment and/or supportive care. Data collection and analysis All review authors independently assessed trial quality and extracted data. We used arithmetic means and standard deviations for each outcome to report the mean difference (MD) with 95% confidence interval (CI).

Main results
Fifteen studies met the inclusion criteria, enrolling 1926 participants. The trial size varied from 20 to 598 patients. Most studies compared corticosteroids, particularly dexamethasone, to standard therapy. We included six studies with data at one week in the metaanalysis for pain intensity; no data were available at that time point for the remaining studies. Corticosteroid therapy resulted in less pain (measured on a scale of 0 to 10 with a lower score indicating less pain) compared to control at one week (MD 0.84 lower pain, 95% CI 1.38 to 0.30 lower; low quality evidence). Adverse events were poorly documented. Factors limiting statistical analysis included the lack of standardised measurements of pain and the use of different agents, dosages, comparisons and routes of drug delivery. Subgroup analysis according to type of cancer was not possible. The quality of this evidence was limited by the risk of bias of the studies and small sample size. The results were also compromised by attrition, with data missing for the enrolled patients.

Authors’ conclusions

The evidence for the efficacy of corticosteroids for pain control in cancer patients is weak. Significant pain relief was noted in some studies, albeit only for a short period of time. This could be important for patients with poor clinical status. Further trials, with increased numbers of participants, are needed to evaluate the safety and effectiveness of corticosteroids for the management cancer pain in adults, and to establish an ideal dose, duration of therapy and route of administration.
Keyword Cancer Pain Management
Corticosteroids
Cancer
Pain -- Treatment
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Mater Research Institute-UQ (MRI-UQ)
UQ Library - Scholarly Communication and Digitisation Services
Official 2016 Collection
School of Medicine Publications
 
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Created: Wed, 29 Apr 2015, 09:14:22 EST by Kirsty Rickett on behalf of Learning and Research Services (UQ Library)