title: The Use of Corticosteroids as Adjuvant Therapy for Painful Bone Metastases: A Large Cross-Sectional Survey of Palliative Care Providers.
abstract: BACKGROUND
  Bone metastases are a common complication in patients with advanced cancer but little is known regarding current practice patterns of palliative care providers when prescribing corticosteroids as adjuvant therapy for painful bone metastases.
  
  
  OBJECTIVE
  To identify current practice patterns among palliative care providers when prescribing corticosteroids for the treatment of painful bone metastases.
  
  
  METHODS
  A cross-sectional, online survey of the membership of the American Academy of Hospice and Palliative Medicine. Providers were asked to report how frequently they prescribed corticosteroids as adjuvant therapy in patients with painful bone metastases, and to specify the corticosteroid, dosage, treatment duration, and the gastroprotective strategy most frequently utilized.
  
  
  RESULTS
  Seven hundred sixty-five participants responded to the survey and 600 (78%) of respondents completed the survey. Ninety-eight percent of respondents completing the survey reported having prescribed corticosteroids as adjuvant pain therapy, and 66% ordered corticosteroids for the majority of their patients with painful bone metastases. Dexamethasone was the most widely prescribed corticosteroid. Eight milligrams divided twice daily was the most common dosage selected and once started, it was usually continued indefinitely.
  
  
  CONCLUSIONS
  Corticosteroids are commonly prescribed as adjuvant therapy in the treatment of painful bone metastases in patients with limited life expectancy. Dexamethasone is the most commonly selected corticosteroid by American palliative care providers with variation existing among providers regarding dosing schedule, treatment duration, and gastroprotective strategies. Clinical trials comparing a total daily dose of four versus eight milligrams of dexamethasone would be clinically useful to inform evidence-based practice.
authors.affiliation: 1 BJC Hospice, St Louis, MO, USA.|2 Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: White
authors.affiliation: 3 Division of General Internal Medicine, Department of Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.|4 Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Arnold
authors.affiliation: 5 Four Seasons Compassion for Life, Flat Rock, NC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Bull
authors.affiliation: 6 Family Hospice and Palliative Care, Pittsburgh, PA, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Cicero
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D000072716:Cancer Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000379:methods*; D010818:Practice Patterns, Physicians'
chemical_list: D000305:Adrenal Cortex Hormones; D005765:Gastrointestinal Agents
keywords: bone metastases; corticosteroids; dexamethasone; hospice; pain; palliative care