title: Aggravation of fatigue by steroid therapy in terminally ill patients with cancer.
abstract: Steroids are commonly used for fatigue relief in terminally ill cancer patients. However, steroid-induced adverse effects including depression, myopathy, and hyperglycemia may contribute to fatigue. We report our experiences with aggravation of fatigue with steroid use in three cases. Case 1 was a 65-year-old man with advanced gastric cancer. He was started on betamethasone (2 mg/d) for fatigue, but the fatigue worsened due to steroid-induced depression. Discontinuation of steroids and initiation of an antidepressant ameliorated the fatigue. Case 2 was a 68-year-old man with advanced lung cancer. He complained of fatigue. Betamethasone (1 mg/d) was started and alleviated the fatigue. However, when the betamethasone dose was increased to 2 mg/d, the fatigue, with muscle weakness and myalgia, worsened due to steroid-induced myopathy. We therefore switched from betamethasone (2 mg/d) to prednisolone (10 mg /d). The fatigue resolved and the patient returned to his previous condition. Case 3 was a 73-year-old man with recurrent bile duct cancer. He also had diabetes mellitus. He developed fatigue, anorexia and fever. We started betamethasone (1.5 mg/d) for these symptoms, but the fatigue and anorexia worsened due to steroid-induced hyperglycemia. Blood glucose rose to 532 mg/dL. Therefore, insulin therapy was started, and the dose of betamethasone was reduced to 0.5 mg/d. His glucose level decreased to less than 320 mg/dL and he recovered from the fatigue while achieving moderate oral intake. In conclusion, the possibility of steroid-induced secondary fatigue in terminally ill cancer patients should be taken into consideration.
authors.affiliation: 1Hospice, Medical corporation Junkei-kai Sotoasahikawa Hospital, Akita, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuo
authors.forename: Kinomi
authors.initials: K
authors.lastname: Yomiya
mesh_terms: D000368:Aged; D001623:Betamethasone / Q000009:adverse effects* / Q000627:therapeutic use; D001650:Bile Duct Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000139:chemically induced; D005221:Fatigue / Q000139:chemically induced* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D008175:Lung Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced; D009369:Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy; D013274:Stomach Neoplasms / Q000150:complications / Q000523:psychology / Q000628:therapy
chemical_list: D001623:Betamethasone
keywords: adverse effect; depression; fatigue; hyperglycemia; myopathy; steroid