A study on the management of corticosteroid side effects in cancer patients

Abstract

Background Systemic corticosteroids lead to many adverse effects especially in cancer patients. Preventive measures and treatment options are essential to minimise such side effects. Objectives The aims of the study included the evaluation of the prescribers’ management of corticosteroid induced hyperglycaemia, dyspepsia, oral candidiasis and proximal myopathy, the discussion of possible reasons for non-adherence to guidelines, and the recommendation of interventions to reduce their risk of occurrence. Method A retrospective review of the medical records for 156 consecutive patients at oncology out-patients and in oncology wards of Boffa Hospital between the 1st and the 14th September 2014 was performed. Only patients who were on long term corticosteroids (>2 weeks’ duration) were considered. Patients younger than 12 years of age or those that were prescribed corticosteroids for antiemetic purposes were excluded from the study. For each of the sampled patients, any management aimed at reducing corticosteroid side effects was compared to the guidelines as stated in an article published in a prominent international journal. Results From 156 cancer patients, 55 patients satisfied the inclusion criteria. The mostly addressed side effect was dyspepsia (n=35; 63.6%) followed by proximal myopathy (n=27; 49%), hyperglycaemia (n=24; 43.6%) and lastly oral candidiasis (n=20; 36%). Adherence to guidelines was as follows: hyperglycaemia – haemo-glucose test (HGT) and glycated haemoglobin (HbA1c) (36%); dyspepsia - prescribing of omeprazole (51%) and ranitidine (5%); oral candidiasis - orophargyngeal exam (29%); and proximal myopathy (40% compliance; of which 35% complying with resistance and endurance exercise and 5% complying with steroid dose reduction). Conclusion Improvement is required with regards to the management of corticosteroid side effects especially for hyperglycaemia and oral candidiasis. Possible actions that may be taken include strategies to improve guideline awareness, the prescribing of the lowest effective dose, adequate patient education and the implementation of a steroid card.