Background Glucocorticoids are widely used for symptom and disease control in patients with cancer. Despite this, there is no recent data on the prevalence of glucocorticoid treatment, or guidance regarding weaning, within this population. This study aimed to determine the point prevalence of glucocorticoid treatment within oncology inpatients at a large tertiary hospital.
Methods On 08.08.2017, the notes of all oncology inpatients in the hospital were reviewed (n=50). Further data was then collected regarding: cancer diagnosis, glucocorticoid indication, weaning plan, and capillary blood glucose (CBG) measurement in the preceding 24 hours.
Results 18 out of 50 (36%) oncology inpatients were taking glucocorticoids. The underlying cancer diagnoses were skewed towards rarer cancers (sarcomas n=7, brain tumours n=3, other diagnoses n=8), reflecting the study's tertiary setting.
The reasons for glucocorticoid treatment included cerebral oedema, queried metastatic spinal cord compression, and immunotherapy related complications.
One patient had a documented short prognosis and was therefore excluded from further analysis. Of the remaining 17 patients,13 (77%) had documented evidence of a glucocorticoid weaning plan in the previous week. This included 5 patients who were prescribed glucocorticoids as part of an elective inpatient chemotherapy regime.
Only 6 patients out of 17 (35%) had a recorded CBG in the preceding 24 hours; this includes 3 patients with pre-existing diabetes.
Discussion This study, though small, demonstrates the high prevalence of glucocorticoid use within oncology. Weaning of glucocorticoids appears to have been considered in most patients, though not all. Measuring CBGs does not appear to be routine, though it was not possible to determine which patients were at high risk of steroid induced hyperglycaemia.
This pilot suggests further study into the prevalence and management of glucocorticoids in patients with cancer, across all settings, would be beneficial to establish the need for formal guidelines.
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