Predictors of Responses to Corticosteroids for Cancer-Related Fatigue in Advanced Cancer Patients: A Multicenter, Prospective, Observational Study

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• 作者：Naoki Matsuo ; MD^a ; ^{matsuo@jkk-sotohp.or.jp" class="auth_mail" title="E-mail the corresponding author} ; Tatsuya Morita ; MD^b ; Yoshinobu Matsuda ; MD^c ; Kenichiro Okamoto ; MD ; PhD^d ; Yoshihisa Matsumoto ; MD ; PhD^e ; Keisuke Kaneishi ; MD ; PhD^f ; Takuya Odagiri ; MD^g ; Hiroki Sakurai ; MD^h ; Hideki Katayama ; MD ; PhDⁱ ; Ichiro Mori ; MD^j ; Hirohide Yamada ; MD^k ; Hiroaki Watanabe ; MD^l ; Taro Yokoyama ; MD^m ; Takashi Yamaguchi ; MD ; PhDⁿ ; Tomohiro Nishi ; MD^o ; Akemi Shirado ; MD^k ; Shuji Hiramoto ; MD^p ; Toshio Watanabe ; MD^q ; Hiroyuki Kohara ; MD ; PhD^r ; Satofumi Shimoyama ; MD ; PhD^s ; Etsuko Aruga ; MD ; PhD^t ; Mika Baba ; MD^u ; Koki Sumita ; MD^v ; Satoru Iwase ; MD ; PhD^w
• 关键词：Fatigue ; corticosteroids ; predictors ; cancer ; palliative care
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：52
• 期：1
• 页码：64-72
• 全文大小：346 K

文摘

Although corticosteroids are widely used to relieve cancer-related fatigue (CRF), information regarding the factors predicting responses to corticosteroids remains limited.

Objectives

The aim of this study was to identify potential factors predicting responses to corticosteroids for CRF in advanced cancer patients.

Methods

Inclusion criteria for this multicenter, prospective, observational study were patients who had metastatic or locally advanced cancer and had a fatigue intensity score of 4 or more on a 0–10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting two-point reduction or more in NRS on day 3.

Results

Among 179 patients who received corticosteroids, 86 (48%; 95% CI 41%–56%) had a response with two-point reduction or more. Factors that significantly predicted responses were performance status score of 3 or more, Palliative Performance Scale score more than 40, absence of ascites, absence of drowsiness, absence of depression, serum albumin level greater than 3 mg/dL, serum sodium level greater than 135 mEq/L, and baseline NRS score greater than 5. A multivariate analysis showed that the independent factors predicting responses were baseline NRS score greater than 5 (odds ratio [OR] 6.6, 95% CI 2.8–15.4), Palliative Performance Scale score more than 40 (OR 4.4, 95% CI 2.1–9.3), absence of drowsiness (OR 3.4, 95% CI 1.7–6.9), absence of ascites (OR 2.3, 95% CI 1.1–4.7), and absence of pleural effusion (OR 2.2, 95% CI 1.0–5.0).

Conclusion

Treatment responses to corticosteroids for CRF may be predicted by baseline symptom intensity, performance status, drowsiness, and severity of fluid retention symptoms. Larger prospective studies are needed to confirm these results.