Faculty, Staff and Student Publications
Publication Date
10-1-2022
Journal
Lancet Oncology
Abstract
BACKGROUND: Systemic corticosteroids are commonly prescribed for palliation of dyspnoea in patients with cancer, despite scarce evidence to support their use. We aimed to assess the effect of high-dose dexamethasone versus placebo on cancer-related dyspnoea.
METHODS: This double-blind, multi-site, parallel group randomized trial enrolled ambulatory patients with cancer, age ≥18, average dyspnea intensity over the past week ≥4/10 in a 0–10 point numeric rating scale and randomly assigned them to receive dexamethasone 8 mg orally every 12 hours for 7 days followed by 4 mg orally every 12 hours for 7 days or matching placebo capsules. Pharmacists conducted permuted block randomization (block size=6, 2:1) stratified by baseline dyspnea and study site. Patients, research staff and clinicians were blinded. The primary outcome was change in dyspnea intensity assessed with a 0–10 numeric rating scale (0=none, 10=worst) between baseline and day 7. Comparisons between groups were done by modified intention-totreat analysis. This study is registered with ClinicalTrials.gov, NCT03367156. Enrollment was stopped after second pre-planned interim analysis when futility criterion was met.
FINDINGS: Between Jan 11, 2018, and April 23, 2021, we screened 2867 patients, enrolled 149 patients, and randomly assigned 128 to dexamethasone (n=85) or placebo (n=43). The mean change in dyspnoea NRS intensity from baseline to day 7 (±2 days) was -1·6 (95% CI -2·0 to -1·2) in the dexamethasone group and -1·6 (-2·3 to -0·9) in the placebo group, with no significant between-group difference (mean 0 [95% CI -0·8 to 0·7]; p=0·48). The most common all-cause grade 3-4 adverse events were infections (nine [11%] of 85 patients in the dexamethasone group vs three [7%] of 43 in the placebo group), insomnia (seven [8%] vs one [2%]), and neuropsychiatric symptoms (three [4%] vs none [0%]). Serious adverse events, all resulting in hospital admissions, were reported in 24 (28%) of 85 patients in the dexamethasone group and in three (7%) of 43 patients in the placebo group. No treatment-related deaths occurred in either group.
INTERPRETATION: High-dose dexamethasone did not improve dyspnoea in patients with cancer more effectively than placebo and was associated with a higher frequency of adverse events. These data suggest that dexamethasone should not be routinely given to unselected patients with cancer for palliation of dyspnoea.
FUNDING: US National Cancer Institute.
Keywords
Adrenal Cortex Hormones, Dexamethasone, Double-Blind Method, Dyspnea, Humans, Neoplasms, Treatment Outcome, Corticosteroids, dyspnea, neoplasms, pharmacologic therapy, palliative care, randomized controlled trial
DOI
10.1016/S1470-2045(22)00508-3
PMID
36087590
PMCID
PMC10618956
PubMedCentral® Posted Date
November 2023
PubMedCentral® Full Text Version
Author MSS
Published Open-Access
yes
Included in
Bioinformatics Commons, Biomedical Informatics Commons, Medical Sciences Commons, Oncology Commons
Comments
Supplementary Material
PMID: 36087590