title: Investigation of Optimal Time for Starting Betamethasone Using Fatigue Scores and Prognostic Nutritional Index in Terminally Ill Patients With Cancer-Related Fatigue.
abstract: BACKGROUND
  Corticosteroids are frequently used to treat cancer-related fatigue (CRF), but it is yet to be established as standard care, and few reports have defined the appropriate time to start treatment.
  
  
  OBJECTIVE
  We investigated the optimal time for starting betamethasone and evaluated the clinical validity of using the prognostic nutritional index (PNI) for this purpose.
  
  
  METHODS
  Data were retrospectively collected for patients with terminal cancer receiving betamethasone for palliative care. Fatigue strength was evaluated by the daily occurrence of fatigue, using proportion of adequate fatigue, AF(%), defined as the average of the daily score for all treatment days, AF(%)all, the initial 5 days, AF(%)initi5, or the last 5 days, AF(%)last5. We examined (1) the relationship between survival time and adequate fatigue for CRF and (2) the correlation between survival time and PNI (based on serum albumin and lymphocytes).
  
  
  RESULTS
  Data from 24 patients were included. The AF(%)allwas approximately 50% at 42 days before death and gradually decreased as the survival time shortened ( R2=.41, P <.001). There was a clear positive correlation between AF(%)alland AF(%)initi5( R2=.84, P <.001). At 42 days before death, PNI was approximately 30 and significantly correlated with the survival time ( R2= .873, P <.001).
  
  
  CONCLUSIONS
  The adequate fatigue appears to be dependent on survival time, and PNI might be useful for identifying patients that will benefit from betamethasone use. It is hoped that these results will contribute to individualized pharmacotherapy of terminally ill patients with CRF.
authors.affiliation: 1 Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Koyama
authors.affiliation: 1 Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Matsumura
authors.affiliation: 2 Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Morii
authors.affiliation: 2 Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Hasegawa
authors.affiliation: 2 Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Hira
authors.affiliation: 3 Department of Medical Oncology, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Yataro
authors.initials: Y
authors.lastname: Daigo
authors.affiliation: 2 Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Terada
authors.affiliation: 1 Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, Kyoto, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Yano
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications*; D009752:Nutritional Status; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D012737:Sex Factors; D019452:Terminally Ill; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones; D001623:Betamethasone
keywords: betamethasone; cancer-related fatigue; corticosteroid; prognosis nutritional index; survival time; terminally ill patients