Hospice, Sotoasahikawa Hospital, Akita, Japan.
J Palliat Med. 2012 Sep;15(9):1011-6; quiz 117-8. doi: 10.1089/jpm.2011.0534. Epub 2012 Jun 26.
Although corticosteroids are commonly used for symptom relief in the treatment of patients with advanced cancer, few studies have addressed nationwide physician-reported practices and attitudes toward corticosteroid therapy in palliative care settings.
To clarify physician-reported practices and attitudes toward corticosteroid therapy for anorexia, fatigue, and dyspnea, a 15-item questionnaire was mailed to all 178 certified palliative care units in Japan.
In total, 124 physicians returned questionnaires (response rate of 70%). The median percentage receiving corticosteroids among all terminally ill cancer inpatients was 80% (fatigue, 80%; anorexia, 80%; dyspnea, 80%). Physicians reported varying methods and attitudes regarding corticosteroid use in palliative care settings. Regarding withdrawal when patient death was imminent, 46% of respondents usually abruptly ceased corticosteroid use, while 33% reduced but did not stop administration, and 21% neither stopped nor reduced corticosteroids. As for dosage, 47% of physicians selected a minimum daily dose for fatigue <2 mg, while 51% chose 2-4 mg. As for administration period, 50% started administering corticosteroids for dyspnea regardless of the prognosis, while 30% regarded a predicted survival of less than 3 months to be an indication for corticosteroid treatment. For side effect management, 48% did not principally prescribe corticosteroids for patients with hyperactive delirium, while 44% cautiously prescribed corticosteroids.
The use of corticosteroids is very common in Japanese palliative care units, but physicians reported varying practices and attitudes regarding administration protocols. Future studies are needed to determine the standard treatment protocol for corticosteroid use in the terminally ill.
尽管皮质类固醇类药物常用于缓解晚期癌症患者的症状，但很少有研究涉及全国范围内医生在姑息治疗环境中报告的皮质类固醇治疗实践和态度。
为了阐明医生对皮质类固醇治疗厌食、疲劳和呼吸困难的报告实践和态度，向日本所有 178 个认证的姑息治疗单位邮寄了一份包含 15 个问题的问卷。
共有 124 名医生回复了问卷（回复率为 70%）。所有终末期癌症住院患者接受皮质类固醇治疗的中位数百分比为 80%（疲劳 80%、厌食 80%、呼吸困难 80%）。医生报告了在姑息治疗环境中使用皮质类固醇的不同方法和态度。关于患者即将死亡时是否停药，46%的受访者通常突然停止使用皮质类固醇，而 33%的受访者减少但不停止给药，21%的受访者既不停止也不减少皮质类固醇。关于剂量，47%的医生选择用于疲劳的最小日剂量<2mg，而 51%的医生选择 2-4mg。关于给药时间，50%的医生开始给予皮质类固醇治疗呼吸困难，而不管预后如何，30%的医生认为预测生存时间<3 个月是皮质类固醇治疗的指征。关于副作用管理，48%的医生主要不为有活动过度性谵妄的患者开皮质类固醇，而 44%的医生谨慎开皮质类固醇。
皮质类固醇类药物在日本姑息治疗单位中使用非常普遍，但医生报告的给药方案存在差异。需要进一步的研究来确定终末期患者使用皮质类固醇的标准治疗方案。
