title: The existential impact of starting corticosteroid treatment as symptom control in advanced metastatic cancer.
abstract: Treatment with corticosteroids often results in increased appetite, reduced nausea and improved well-being in patients with advanced metastatic cancer. Therefore, we have studied the existential impact of starting corticosteroid treatment as symptom control in this patient group using qualitative content analysis with both a descriptive and an interpretative focus. Ten patients were interviewed before and after 1 week of treatment with 4 mg betamethasone. Prior to treatment, patients reported distressing symptoms, deterioration and diminished autonomy, symbolising threat and death. Corticosteroid treatment produced symptom relief in the majority of the patients. They reported enhanced physical abilities and experienced feelings of a more normalized life and strengthened autonomy, symbolising health and hope. This transfer from threat to hope has important existential consequences in end-of-life care and should be addressed when communicating goals of treatment and care with the patient and family.
authors.affiliation: Palliative Care Services, Stockholms Sjukhem Foundation, Stockholm, Sweden. staffan.lundstrom@stockholmssjukhem.se
authors.forename: S
authors.initials: S
authors.lastname: Lundström
authors.forename: C J
authors.initials: CJ
authors.lastname: Fürst
authors.forename: M
authors.initials: M
authors.lastname: Friedrichsen
authors.forename: P
authors.initials: P
authors.lastname: Strang
mesh_terms: D000223:Adaptation, Psychological; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000627:therapeutic use*; D005086:Existentialism / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D036301:Qualitative Research; D013548:Sweden; D019452:Terminally Ill / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D001623:Betamethasone