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A Prospective Randomized Study of Corticosteroids as Adjuvant Drugs to Opioids in Advanced Cancer Patients

Palliative Medicine, Anesthesiology, Intensive Care, and Emergency, University of Palermo, Italy; Anesthesia and Intensive Care Unit & Pain Relief & Palliative Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy; terapiadeldolore{at}la-maddalena.it

Michela Berchovich, MD

Tel Hashomer Hospice, The Chaim Sheba Medical Center, Tel Hashomer, Israel

Alessandra Casuccio, BS

Section of Ophthalmology, University of Palermo, Italy

Fabio Fulfaro, MD

Department of Oncology, University of Palermo, Italy

Salvatore Mangione, MD

Palliative Medicine, Anesthesiology, Intensive Care, and Emergency, University of Palermo, Italy

This randomized controlled study evaluated the role of corticosteroids as adjuvants to opioid therapy in 76 advanced cancer patients with pain who requiring strong opioids. Patients were divided in 2 groups. Group O received conventional opioid treatment. Group OS received dexamethasone (8 mg orally) along with conventional treatment. Pain and symptom intensity, sense of well-being, and opioid escalation index and distress score were recorded at weekly intervals until death. No differences in pain intensity, opioid consumption, and opioid escalation index were found in 66 patients who survived 33 to 37 days. Corticosteroids did not provide significant additional analgesia to opioids, but persistently decreased opioid-related gastrointestinal symptoms for the patients with limited survival and improved the sense of well-being for some weeks. Corticosteroidrelated toxicity was minimal. Further studies with an increased sample size are necessary to detect any minimal difference in analgesia between the two groups.

Key Words: cancer pain • corticosteroids • opioids • adjuvant

American Journal of Hospice and Palliative Medicine®, Vol. 24, No. 1, 13-19 (2007)
DOI: 10.1177/1049909106295431


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