title: Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study.
abstract: Although corticosteroids can relieve dyspnea in advanced cancer patients, factors predicting the response remain unknown. We aimed to explore potential factors predicting the response to corticosteroids for dyspnea in advanced cancer patients.
  
  
  
  In this preliminary multicenter prospective observational study, we included patients who had metastatic or locally advanced cancer, were receiving specialized palliative care services, and had a dyspnea intensity of ≥3 on a 0-10 Numerical Rating Scale (NRS) (worst during the last 24 h). The primary endpoint was NRS of dyspnea on day 3 after the administration of corticosteroids. Univariate/multivariate analyses were conducted to identify factors predicting ≥1-point reduction in NRS.
  
  
  
  Of 74 patients who received corticosteroids, 50 (68%) showed ≥1-point reduction in dyspnea NRS. Factors that significantly predicted the response were an age of 70 years or older (82 vs. 53%, p = 0.008), absence of liver metastases (77 vs. 46%, p = 0.001), Palliative Prognostic Index (PPI) ≤ 6 (90 vs. 61%, p = 0.041), presence of pleuritis carcinomatosa with a small collection of pleural effusions (84 vs. 55%, p = 0.011), presence of audible wheezes (94 vs. 60%, p = 0.014), and baseline dyspnea NRS ≥7 (76% vs. 52%, p = 0.041). In a multivariate analysis, factors predicting response included PPI <6 (odds ratio (OR), 36.2; p = 0.021), baseline dyspnea NRS (worst) ≥7 (OR, 6.6; p = 0.036), and absence of liver metastases (OR, 0.19; p = 0.029) or ascites/liver enlargement (OR, 0.13; p = 0.050).
  
  
  
  The patient characteristics, etiologies of dyspnea, and clinical manifestations may predict responses to corticosteroids for dyspnea. Larger prospective studies are promising to confirm our findings.
authors.affiliation: Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan. masanori.mori@sis.seirei.or.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Mori
authors.affiliation: Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan.
authors.forename: Akemi Naito
authors.initials: AN
authors.lastname: Shirado
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Palliative Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo, Tsuduki-ku, Yokohama-shi, Kanagawa, 224-8503, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, 591-8555, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
authors.forename: Hirohide
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Department of Palliative Care, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Palliative Medicine, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Aruga
authors.affiliation: Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku, Tokyo, 162-0815, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kaneishi
authors.affiliation: Komaki City Hospital, 1-20 Jobushi, Komaki City, Aichi, 485-8520, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watanabe
authors.affiliation: Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Komaki City Hospital, 1-20 Jobushi, Komaki City, Aichi, 485-8520, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Odagiri
authors.affiliation: Department of Oncology, Katsura Goshocho1, Nisikyo-ku, Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hiramoto
authors.affiliation: Department of Palliative Care, Hiroshima Prefectural Hospital, 1-5-54,Ujina-kanda, Minami-ku, Hiroshima, 734-8530, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kohara
authors.affiliation: Hospice, Medical Corporation Junkei-kai Sotoasahikawa Hospital, 42, Aza-Sangoden, Sotoasahikawa, Akita, 010-0802, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsuo
authors.affiliation: NHO Yamaguchi-Ube Medical Center, 685, Higashi-Kiwa, Ube, Yamaguchi, 755-0241, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Katayama
authors.affiliation: Kawasaki Municipal Ida Hospital, Nakahara-ku Ida 2-27-1, Kawasaki-shi, Kanagawa, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Palliative Medicine, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Iwase
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000503:physiopathology*; D010166:Palliative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Cancer; Corticosteroids; Dyspnea; Palliative care; Predictors