RESUMO
PURPOSE: Glucocorticoids are commonly used in patients with cancer for symptom relief or as part of their anticancer treatment. Despite their frequent use, indications and dosing regimens are not exclusively evidence-based and can come with a multitude of adverse effects, some of which can be life-threatening. The objective of this review is to update our current state of knowledge on the use of glucocorticoids in adult patients with cancer. METHODS AND MATERIALS: A comprehensive literature review (1949-2022) was conducted using search terms "glucocorticoids," "corticosteroids," and "cancer." Information was organized by main concepts including indications, potential benefits, and prevention and management of common side effects of glucocorticoid therapy, in addition to appropriate dosing and taper regimens. RESULTS: Glucocorticoids can be highly effective in improving outcomes and quality of life in patients with cancer. Their uses include management of disease manifestations, symptoms, and complications of cancer treatment. The lowest effective dose should be used and treatment duration should be minimized as clinically feasible. Side effects can be minimized by careful monitoring, continued assessment of benefits versus harms, and preventative measures for expected side effects. CONCLUSIONS: This review provides general principles and practical recommendations on the use of glucocorticoids in patients with cancer. Further prospective studies on the outcomes of patients on glucocorticoids may help guide practice.
Assuntos
Glucocorticoides , Neoplasias , Adulto , Humanos , Glucocorticoides/efeitos adversos , Qualidade de Vida , Estudos Prospectivos , Corticosteroides/efeitos adversos , Neoplasias/tratamento farmacológicoRESUMO
End-stage liver disease (ESLD) is an increasingly prevalent condition with high morbidity and mortality, especially for those ineligible for liver transplantation. Patients with ESLD, along with their family caregivers, have significant needs related to their quality of life, and there is increasing attention being paid to integration of palliative care (PC) principles into routine care throughout the disease spectrum. To provide upstream care for these patients and their family caregivers, it is essential for PC providers to understand their complex psychosocial and physical needs and to be aware of the unique challenges around medical decision making and end-of-life care for this patient population. This article, written by a team of liver and PC experts, shares 10 high-yield tips to help PC clinicians provide better care for patients with advanced liver disease.
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Doença Hepática Terminal , Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Humanos , Cuidados Paliativos , Qualidade de VidaRESUMO
The primary objective of this study was to identify significant environmental and patient characteristics of emergency department (ED) patients who responded to intravenous (IV) hydromorphone and IV morphine for severe pain. Secondary objectives were to investigate the individual effect of the significant environmental and patient characteristics of responders, and to assess the nature and strength of the correlation of initial dose and change in pain score from arrival to pre-administration. A retrospective chart review was performed in patients who received IV hydromorphone or morphine in the ED for severe pain. Key evaluated patient characteristics included patient demographics, recent opioid use, history of drug or alcohol abuse, and pain location, among others. Key evaluated environmental characteristics included initial opioid administered, time to first dose, initial pain score, and initial dose of opioid administered, among others. Environmental and patient characteristics associated with response to pain management were first identified using bivariate analyses and then entered into a multiple stepwise logistic regression mode. Patients were excluded if they were younger than 18 years, did not have a follow-up pain score within 2 hours of drug administration, or if they were discharged from the ED within 1 hour of administration. Patients meeting the inclusion criteria were grouped into two cohorts based on response and lack of response to treatment. A total of 200 patients were included. A decrease in pain score from arrival until pre-administration pain score and an inactive tobacco history had a positive association with response (odds ratio [OR] 1.488, 95% confidence interval [CI] 1.088-2.036, p=0.013, and OR 1.835, 95% CI 0.801-4.200, overall p=0.022, respectively). A higher initial dose and an active tobacco history had a negative association with response (OR 0.715, 95% CI 0.580-0.881, p=0.002, and OR 0.582, 95% CI 0.296-1.144, overall p=0.022, respectively). Two characteristics were associated with response to IV opioid pain management in the ED, inactive tobacco history and an increase in pain score from arrival until pre-administration, and two characteristics were associated with nonresponse to IV opioid pain management in the ED, active tobacco history and a higher initial dose. Previous literature supports both characteristics identified as risk factors but does not support either characteristic identified as protective factors, prompting the need for further research.