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Pharmacovigilance in hospice/palliative care: the net immediate and short-term effects of dexamethasone for anorexia
  1. Yutaka Hatano1,2,
  2. Matteo Moroni3,
  3. Andrew Wilcock4,
  4. Stephen Quinn5,
  5. Ágnes Csikós6,
  6. Simon G Allan7,
  7. Meera Agar2,8,
  8. Katherine Clark9,
  9. Josephine M Clayton10 and
  10. David C Currow2
  1. 1Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  2. 2Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
  3. 3MariaTeresa Chiantore Seràgnoli Hospice Foundation, Bologna, Italy
  4. 4Palliative Medicine and Medical Oncology, School of Medicine, University of Nottingham, Nottingham, UK
  5. 5School of Medicine, Flinders University, Adelaide, South Australia, Australia
  6. 6Hospice—Palliative Department, UP MS Family Medicine Institute, Pecs, Hungary
  7. 7Director of Palliative Care, Arohanui Hospice, Palmerston North, New Zealand
  8. 8Braeside Hospital, HammondCare, Sydney, New South Wales, Australia
  9. 9Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
  10. 10HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Professor David C Currow, Discipline, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; david.currow{at}health.sa.gov.au

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.

  • Terminal care
  • Drug administration
  • Pharmacology
  • Received 8 October 2015.
  • Revision received 9 March 2016.
  • Accepted 21 May 2016.

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  • Received 8 October 2015.
  • Revision received 9 March 2016.
  • Accepted 21 May 2016.
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