The use of corticosteroids for symptom management in terminally ill patients.

Introduction The adrenocorticosteroids, (steroids), are importantchemicalcompoundsthat appearto have several beneficialeffectson symptomsof patientswith tenninaldisease.Although steroids have beenused widely for symptommanagement, theyare used very little outsidethe hospicesetting! There is an abundant,although anecdotal,literaturethatdescribesthe virtues of steroidsfor symptommanagement.The limited useof these agentsby non-hospicephysiciansis probablypartially dueto a paucityof well controlled clinical trials, plus muchoftheexistingliteratureis outof the main-streamof physicianreadership. Steroids,in addition to having specifictherapeuticanti-inflammatory effects,bothin cancerandnon-cancer situations,havea number of rather nonspecificeffectsfor whichtheyare usedin the treatmentof thetenninally ill. Theanti-inflammatoryeffectseems usefultoreducetheedemazonearound malignant accumulation.There are alsononspecificeffectsthatarehelpful for a wholehostof disturbingsymptoms causedby the primarydisease. (SeeTableI.) The purposeof this paper is to reviewourexperiencewith theuseof corticosteroidsin patientswith terminal disease, duringafive yearperiod at St. Mary’s Hospice in Tucson. In addition, this paperwill discussthe shortcomingsof theliteratureandsuggesta rationalapproachto the useof theseimportantagentsas we wait for moreandbetterresearchdata.