Corticosteroids, commonly referred to as steroids, are synthetic drugs that mimic hormones naturally produced by the body’s adrenal glands. These substances play various roles in regulating the body’s response to injury, infection, and metabolism. In cancer treatment, these manufactured steroids are frequently administered alongside chemotherapy to improve patient outcomes and manage treatment-related symptoms.
Multifaceted Roles of Steroids in Chemotherapy
One significant role of steroids, particularly dexamethasone, in chemotherapy is their ability to prevent and reduce chemotherapy-induced nausea and vomiting (CINV). Dexamethasone is often a first-line medication for preventing mild to moderate CINV and is combined with other antiemetics like 5-HT3 receptor antagonists for highly emetogenic chemotherapy regimens. This anti-nausea effect is thought to involve multiple mechanisms, including anti-inflammatory actions and interactions with neurotransmitters like serotonin in the brain’s vomiting centers.
Beyond nausea, steroids also exert strong anti-inflammatory effects, which can help alleviate pain and swelling associated with cancer and its treatments. For instance, they can reduce swelling around tumors in the brain or spinal cord, thereby relieving pressure and discomfort. This anti-inflammatory action also contributes to their ability to manage pain, sometimes used alongside opioids for bone or neuropathic pain.
Steroids also help in preventing or lessening allergic reactions to certain chemotherapy drugs. Chemotherapy can sometimes trigger hypersensitivity reactions, and steroids can help control these responses, allowing patients to continue their treatment safely. This protective effect is particularly valuable when patients need contrast dyes for imaging procedures like CT scans, where allergic reactions can occur.
Certain types of steroids, specifically corticosteroids like prednisone and dexamethasone, have direct anti-cancer effects on particular cancer cells. They are often a component of the chemotherapy regimen itself for conditions such as lymphomas, leukemias, and multiple myeloma. These steroids work by inducing programmed cell death, or apoptosis, in these lymphoid cancer cells and can enhance the effectiveness of other chemotherapy agents.
Common Side Effects and Management
Patients receiving steroids with chemotherapy may experience various short-term side effects. These can include:
- Increased appetite and subsequent weight gain, as steroids can make individuals feel hungrier.
- Insomnia and sleep disturbances.
- Mood changes, such as irritability or a feeling of euphoria.
- Fluid retention, leading to swelling in the hands and feet.
- Elevated blood sugar levels, requiring close monitoring, especially for individuals with diabetes.
- Heartburn or stomach irritation.
While steroid use with chemotherapy is often short-term, typically for a few days to a few weeks, longer durations can lead to other effects. Prolonged steroid use might increase the risk of bone thinning (osteoporosis), muscle weakness, and a suppressed immune system, making patients more susceptible to infections. Less common long-term effects can include cataracts or glaucoma. Healthcare providers carefully consider the duration and dosage of steroids to minimize these potential long-term issues.
Managing these side effects often involves adjusting the timing of doses, such as taking steroids in the morning to reduce sleep disruption. Dietary adjustments can help with increased appetite and blood sugar control. Open communication with the healthcare team is encouraged to report any side effects, allowing for timely interventions like dose adjustments or prescription of additional medications to alleviate symptoms.
Important Considerations for Patients
Adherence to the prescribed dosage and schedule is important when taking steroids with chemotherapy. It is important to take steroids exactly as directed by the healthcare team and not to stop them abruptly, even if feeling better. Suddenly discontinuing steroids can lead to withdrawal effects, including fever, aching muscles, or a general feeling of unwellness, as the body needs time to restart its natural steroid production.
Patients should maintain open and consistent communication with their healthcare team. Reporting any new or worsening side effects, questions, or concerns promptly is important for effective management and safety. This allows the team to make necessary adjustments to the treatment plan, such as modifying the steroid dose or exploring alternative supportive medications.
Steroids can be administered in several ways, including orally as pills or liquids, or intravenously through an injection. The specific method and dose depend on the type of chemotherapy regimen, the type of cancer, and the individual patient’s needs. Treatment plans, including steroid use, are highly individualized, tailored to each patient’s unique condition and response to therapy.