title: Role of corticosteroids for fatigue in advanced incurable cancer: is it a 'wonder drug' or 'deal with the devil'.
abstract: OBJECTIVE
  Although corticosteroids are frequently used to palliate cancer-related symptoms, limited published studies are available. This review summarizes recent literature on the impact of corticosteroids on fatigue, its related symptoms, and the role of 'corticosteroid rotation' in improving the corticosteroid-related side-effects.
  
  
  RESULTS
  Only two placebo-controlled double-blinded randomized studies on corticosteroid for symptoms that met the inclusion criteria were published recently, despite the criteria being extended beyond 2012 and 2013. These two studies confirm the preliminary data that corticosteroids significantly improve cancer-related fatigue and anorexia with no significant side-effects. However, these studies were of short duration. Long-term use of corticosteroids is not recommended at this time because of the risk of debilitating side-effects and no evidence of its long-term benefits. Recent studies also suggest the possible role of corticosteroid rotation or switching similar to opioid rotation for improvement of these side-effects.
  
  
  CONCLUSIONS
  Recent studies confirm the short-term benefit of corticosteroids for the symptomatic treatment of cancer-related fatigue and anorexia cachexia in advanced incurable cancer. Future studies are needed to determine the optimal dose, type, and the role of corticosteroid rotation so as to optimize long-term efficacy and minimize side-effects.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology*; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D009135:Muscular Diseases / Q000139:chemically induced / Q000378:metabolism; D009369:Neoplasms / Q000150:complications*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones