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Pharmacovigilance in hospice/palliative care: The net immediate and short-term effects of dexamethasone for anorexia

Journal Article


Abstract


  • Objectives: Loss of appetite is prevalent in palliative care and distressing for patients and families. Therapies include corticosteroids or progestogens. This study explores the net effect of dexamethasone on anorexia. Methods: Prospective data were collected when dexamethasone was started for anorexia as part of routine care. The National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCICTCAE) Likert scales assessed severity of anorexia and immediate and short-term harms at 2 time points: baseline and 7 days. Results: This study (41 sites, 8 countries) collected data (July 2013 to July 2014) from 114 patients (mean age 71 (SD 11), 96% with cancer). Median Australian-modified Karnofsky Performance Scale was 50% (range 20-70). Mean baseline NCICTCAE anorexia score was 2.7 (SD 0.6; median 3). 6 patients died by day 7. Of 108 evaluable patients, 74 (68.5%; 95% CI 59.0% to 76.7%) reported ���1 reduction anorexia scores by day 7, of whom 30 were 0. Mean dexamethasone dose on day 7 was 4.1 mg/day (SD 3.4; median 4; range 0-46 mg). 24 patients reported ���1 harms (32.4% CI 22.6% to 44.1%; insomnia n=10, depression n=7, euphoria n=7 and hyperglycaemia n=7). Of 24 patients with no benefit, 10 reported ���1 harms. Conclusions: This study shows positive and negative effects of 7 days of dexamethasone as an appetite stimulant in patients with advanced life-limiting illnesses. Identifying clinicodemographic characteristics of people most at risk of harms with no benefit is a crucial next step. Longer term follow-up will help to understand longer term and cumulative harms.

Publication Date


  • 2016

Publisher


Citation


  • Hatano, Y., Moroni, M., Wilcock, A., Quinn, S., Csik��s, ��., Allan, S. G., . . . Currow, D. C. (2016). Pharmacovigilance in hospice/palliative care: The net immediate and short-term effects of dexamethasone for anorexia. BMJ Supportive and Palliative Care, 6(3), 331-337. doi:10.1136/bmjspcare-2015-001037

Scopus Eid


  • 2-s2.0-84986272627

Start Page


  • 331

End Page


  • 337

Volume


  • 6

Issue


  • 3

Place Of Publication


Abstract


  • Objectives: Loss of appetite is prevalent in palliative care and distressing for patients and families. Therapies include corticosteroids or progestogens. This study explores the net effect of dexamethasone on anorexia. Methods: Prospective data were collected when dexamethasone was started for anorexia as part of routine care. The National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCICTCAE) Likert scales assessed severity of anorexia and immediate and short-term harms at 2 time points: baseline and 7 days. Results: This study (41 sites, 8 countries) collected data (July 2013 to July 2014) from 114 patients (mean age 71 (SD 11), 96% with cancer). Median Australian-modified Karnofsky Performance Scale was 50% (range 20-70). Mean baseline NCICTCAE anorexia score was 2.7 (SD 0.6; median 3). 6 patients died by day 7. Of 108 evaluable patients, 74 (68.5%; 95% CI 59.0% to 76.7%) reported ���1 reduction anorexia scores by day 7, of whom 30 were 0. Mean dexamethasone dose on day 7 was 4.1 mg/day (SD 3.4; median 4; range 0-46 mg). 24 patients reported ���1 harms (32.4% CI 22.6% to 44.1%; insomnia n=10, depression n=7, euphoria n=7 and hyperglycaemia n=7). Of 24 patients with no benefit, 10 reported ���1 harms. Conclusions: This study shows positive and negative effects of 7 days of dexamethasone as an appetite stimulant in patients with advanced life-limiting illnesses. Identifying clinicodemographic characteristics of people most at risk of harms with no benefit is a crucial next step. Longer term follow-up will help to understand longer term and cumulative harms.

Publication Date


  • 2016

Publisher


Citation


  • Hatano, Y., Moroni, M., Wilcock, A., Quinn, S., Csik��s, ��., Allan, S. G., . . . Currow, D. C. (2016). Pharmacovigilance in hospice/palliative care: The net immediate and short-term effects of dexamethasone for anorexia. BMJ Supportive and Palliative Care, 6(3), 331-337. doi:10.1136/bmjspcare-2015-001037

Scopus Eid


  • 2-s2.0-84986272627

Start Page


  • 331

End Page


  • 337

Volume


  • 6

Issue


  • 3

Place Of Publication