Dyspnea-alleviating and survival-prolonging effects of corticosteroids in patients with terminal cancer

Abstract

In patients with cancer, dyspnea, which serves as a prognostic factor, increases toward the end of life. Notably, corticosteroid treatment can alleviate dyspnea in this patient population. Therefore, it is important to investigate the effects of corticosteroid responsiveness on patient survival. Accordingly, we retrospectively evaluated these effects and the efficacy of corticosteroids for dyspnea alleviation in patients with terminal cancer. Patients for whom corticosteroid therapy was or was not effective were designated as responders or non-responders, respectively, and survival was compared among patients in both groups. The primary endpoint was patient survival, and the secondary endpoints were the incidence of adverse effects and the effect of combination medicine use on responses to corticosteroids. From January 2012 through December 2015, 52 patients were investigated, and 30 and 22 were classified as responders and non-responders, respectively. Survival significantly increased among responders, compared to that among non-responders (8.5 vs. 5.0 days, P = 0.0019, Mann–Whitney U-test), although the average corticosteroid daily doses (in prednisolone equivalents) did not differ significantly (28.96 ± 12.83 and 29.13 ± 18.48 mg among responders and non-responders, respectively; P = 0.75, unpaired t-test). Observed corticosteroid-related side effects included insomnia (15.4%), delirium (11.5%), and hyperglycemia (3.8%). We attribute the survival difference to responsiveness to corticosteroids, as opposed to differences in patient prognosis related to underlying disease processes that resulted in apparent responses to medication. Our results suggest that further research is needed to evaluate the clinical factors related to corticosteroid combination therapy.