Steroids are a common component of many chemotherapy regimens. In this medical setting, “steroids” typically refers to corticosteroids, synthetic versions of hormones naturally produced by the adrenal glands. These medications play a multifaceted role in cancer treatment, extending beyond just managing symptoms. This article clarifies why corticosteroids are prescribed alongside chemotherapy.
Steroids for Managing Chemotherapy Side Effects
Steroids are frequently used to alleviate various side effects associated with chemotherapy. These medications act as powerful anti-inflammatory agents. Reducing inflammation can help manage issues like pain and swelling.
A primary benefit of steroids like Dexamethasone is their effectiveness in preventing and reducing chemotherapy-induced nausea and vomiting. Dexamethasone is often used with other anti-nausea medications, working by inhibiting the release of prostaglandins, molecules involved in the vomiting pathway, and by acting on the brain’s nausea control center.
Steroids mitigate inflammatory responses throughout the body. Chemotherapy can cause widespread inflammation, contributing to pain and discomfort. Corticosteroids like Prednisone and Methylprednisolone help reduce this inflammation by suppressing pro-inflammatory cytokines and other signaling molecules, alleviating associated symptoms.
Certain chemotherapy drugs can trigger hypersensitivity reactions, which are essentially allergic responses. Steroids are often administered before these specific chemotherapy agents to prevent or lessen the severity of such reactions. For example, they are commonly used as pre-medication for drugs like paclitaxel, which has a higher risk of causing allergic responses.
Steroids can also reduce swelling around tumors, particularly those in sensitive areas like the brain or spinal cord. Tumors can cause fluid buildup (edema) in surrounding tissues, leading to increased pressure and symptoms such as headaches, nausea, weakness, or seizures. Dexamethasone is frequently prescribed for this purpose, helping to reduce swelling and alleviate neurological symptoms.
Steroids as Direct Cancer Therapy
Beyond their supportive role in managing side effects, certain steroids directly contribute to the destruction of cancer cells in specific types of malignancies. This dual function makes them an active component of some chemotherapy regimens.
In blood cancers such as lymphomas and leukemias, steroids like Prednisone and Dexamethasone can directly kill or slow the growth of cancer cells. For instance, in acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL), these corticosteroids cause cell death and inhibit the growth of sensitive lymphoid cancer cells, slowing disease progression.
In these particular cancers, steroids are not merely given for supportive care but are integrated into the chemotherapy regimen to maximize the anti-cancer effect. For example, Prednisone is combined with other cytotoxic agents in ALL treatment to achieve higher remission rates. Dexamethasone is also a component of regimens for multiple myeloma, where it contributes to killing myeloma cells.
Common Steroid Side Effects and Management
Despite their benefits, steroid use during chemotherapy can lead to a range of side effects. Patients commonly experience increased appetite and weight gain, as well as fluid retention, which can cause swelling in the face, hands, or feet. These effects are often related to the dosage and duration of steroid administration.
Mood changes, including irritability, euphoria, or anxiety, are also reported with steroid use. Sleep disturbances such as insomnia are common, particularly if doses are taken late in the day. Increased blood sugar levels can occur, sometimes leading to temporary or new-onset diabetes, which requires careful monitoring.
Steroids can also weaken the immune response, increasing the risk of infections. Other potential side effects include heartburn, muscle weakness, and, with long-term use, bone density loss. Healthcare teams manage these side effects through various strategies, including dietary adjustments to help control weight and blood sugar, and recommending sleep hygiene practices.
Patients are encouraged to maintain open communication with their healthcare team about any experienced side effects. Adjustments to steroid dosage or timing, or the prescription of additional medications, can often help alleviate discomfort. Most side effects are temporary and typically improve or resolve after steroid treatment is completed or the dose is slowly reduced.