Steroids and Cancer - What You Need to Know

Reasons for Use and Side Effects of Corticosteroids with Cancer

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What are the reasons for using steroids for part of your cancer treatment and what are the side effects you need to know?. Tetra Images Brand X Pictures/Getty Images

Steroids are used commonly for people with cancer for a multitude of reasons. What exactly are corticosteroids? What roles do they play in cancer treatment? What are some common short term and long term side effects, and how may they affect your mood?

What are Steroids (Corticosteroids)?

Steroids are chemicals ordinarily produced in our bodies by endocrine glands, which play an important role in regulating bodily functions.

Some of these include the:

  • Regulation of water and salt content of the body
  • Regulation of body temperature
  • Regulation of blood pressure
  • Metabolism of fats, carbohydrates, and proteins
  • Regulating the "stress response" of the body
  • Regulation of inflammation
  • Responding to infection
  • Stress response (see below)

Which Steroids are Used in Cancer Therapy?

When we think of someone taking steroids, we often think of muscle-bound athletes or weight lifters. Recreational steroids, like the ones described above, are called anabolic steroids and are not typically used in cancer care.

Most often, the steroids used for people with cancer are called corticosteroids. Corticosteroids are chemicals naturally produced by the adrenal glands, small endocrine glands which sit just above the kidneys. Examples of these types of steroids are:

  • Cortef (hydrocortisone)
  • Deltasone (prednisone)
  • Prelone (prednisolone)
  • Decadron (dexamethasone)
  • Medrol (methylprednisolone)

When used for cancer, these medications are usually given orally or injected intravenously (for other conditions they may also be part of a topical preparation, injected into joints, or inhaled via a nasal or bronchial inhaler).

(The corticosteroid converter can be used to compare dosages of one of these drugs to another.)

Reasons for Using Steroids in Cancer Treatment

Steroids (corticosteroids) may be used for a wide variety of reasons in the treatment of cancer. This can be confusing, and it is important to ask your oncologist about the specific purpose of the medication you are prescribed.

Possible uses of corticosteroids with cancer include:

  • To help prevent an allergic reaction to a blood product transfusion or medication - Steroids are commonly used (along with antihistamines and other medications) to prevent allergic reactions. Some chemotherapy drugs, such as Taxol (paclitaxel) commonly cause allergic reactions. Allergic reactions to rituximab, a type of targeted therapy used with blood related cancers are extremely common. Steroids are frequently given at the same time as these medications as a preventive measure.
  • To help control chemotherapy-induced nausea and vomiting - As with allergic reactions, steroids are often used along with other medications to prevent or treat nausea.
  • To increase appetite - In our weight conscious society, we often look at weight loss as a plus. Yet cancer cachexia—a constellation of symptoms including unintentional weight loss and muscle wasting—is responsible for around 20 percent of cancer deaths, making it critical to address concerns such as loss of appetite in people with cancer.
  • As part of your chemotherapy regimen.
  • To reduce inflammation.
  • To treat pain.
  • To treat skin reactions.
  • To treat shortness of breath in advanced cancer.
  • To reduce swelling when cancer spreads to the brain (with brain metastases).
  • To reduce swelling in spinal cord compression - Spinal cord compression is a complication often seen with myeloma and with other cancers which have spread to bones (bone metastases).
  • To treat superior vena cava obstruction (a complication of cancer).
  • To help treat bowel obstruction (as a complication of cancer).
  • To treat graft-versus-host disease (GVHD) following stem cell transplant.

    Understanding Cortisol and the Stress Response

    In order to understand how steroids may be used for people with cancer, it's helpful to consider how "natural" steroids function in the body, and the importance of using these medications only as directed.

    When our body's are stressed—whether physically or emotionally—a signal is sent to the pituitary gland, a small endocrine gland in the brain. The pituitary gland sends out a hormone called adrenocorticotropic hormone (ACTH). ACTH, in turn, instructs the adrenal glands (small endocrine glands which sit on top of the kidneys) to release cortisol, a "natural steroid."

    Cortisol then play an important part in managing the stress, through altering inflammation, responding to infection, and a host of other functions. ranging from the control of blood pressure to the control of blood sugar.

    Pharmaceutically produced synthetic steroids function much like cortisol. These powerful medications have many uses in medicine and are a key component in the treatment of blood related cancers, such as leukemia, lymphoma, and myeloma, as well as solid cancers.

    Side Effects of Steroid Use

    The side effects of steroids tend to be worse when they are taken at higher doses and over long periods of time. If you are learning about the side effects, you may find it confusing, since the side effects people experience early on when taking these medications are often the opposite of side effects experienced with long term use. Early on you may notice increased energy on steroids, but over the long term you may notice weakness.

    Understanding "feedback loops" in the production of natural hormones in the body can help to explain this. Being aware of "feeback loops' can also help you understand why you shouldn't suddenly stop these drugs or rapidly decrease your dose if you have been taking them for a long time.

    Early on when taking these drugs (hormones), you can simplistically think of the medication as "supplementing" your body's own production of corticosteroids. With time, your body realizes you are getting all of the corticosteroids you need in pill or intravenous form, and your body sends a message to stop producing your own natural corticosteroids. If these drugs are suddenly stopped, you not only are not getting the prescription, but it can take a significant amount of time before your body realizes that it needs to make its own corticosteroids again.

    Short-term side effects (side effects which occur early or when steroids are used for only a short period of time) include:

    • Insomnia - There are many possible causes of insomnia with cancer, but that associated with steroids, especially those given during chemotherapy, can be severe.
    • Allergic reactions - Rarely, even though steroids are often used for allergic reactions, some people may have an allergic reaction to steroids.
    • Delirium - Confusion and delirium may occur, especially when combined with narcotic pain medications in people with advanced cancer.

    Long-term side effects of steroids are common and may include:

    • Immune suppression and infections - Steroids alone can lead to immune suppression which, when added to bone marrow suppression due to cancer in the marrow or chemotherapy, can become severe. This can increase your risk of infection or result in infections being more serious.
    • Weight gain - People who take steroids for an extended amount of time often end up with what is called "moon facies" in which extra fat builds up on the side of the face.
    • Weakness (especially proximal muscle weakness).
    • Psychosis or mood swings (see below).
    • Stomach ulcers and gastritis - Sometimes people on steroids are given a prescription medicine to reduce the likelihood of developing ulcers.
    • Elevated blood pressure.
    • Sleep disturbances.
    • Elevated blood sugar (especially important if you are a diabetic) - It's not uncommon when high doses of steroids are used for a person to become "temporarily" diabetic and require insulin treatment (steroid-induced diabetes).
    • Osteoporosis (brittle bones) - Even short term use of steroids can result in significant bone loss, which can, in turn, increase the risk of fractures.
    • Swollen hands or feet due to water and salt retention.
    • Cataracts.
    • Acne.

    Some side effects may be good or bad depending on a person's clinical situation. For example, increased appetite and weight gain may be beneficial in underweight people with cancer.

    Taking your medication with food can help with some of the problems that steroids can cause to your digestive tract. You may also choose to take these types of medications early on in the day so that they are less likely to impact your sleep at night.

    As with many medication side effects, your oncologist, nurse, or pharmacist can often provide you with strategies to help control or minimize them. Make sure to let your doctor know if you experience any symptoms or side effects.

    Impact of Steroids on Mood

    While you may have heard the expression "roid rage," which is used to describe angry behaviors and outbursts of individuals who take anabolic steroids, it's important to note that corticosteroids can also have serious effects on mood.

    The psychological side effects of corticosteroids can range from irritability, restlessness, and anger all the way to paranoia, confusion, and mania. Conversely, it is not uncommon to have a low mood or even depression after you discontinue these medications.

    Unfortunately, with all that is going on in your life with cancer, it may be difficult to determine the source of these feelings. Yes, you are on steroids, but you are also getting treated for cancer and trying to carry on a somewhat normal life. It's normal to experience a wide range of emotions when coping with cancer.

    A general rule of thumb is that if your mood changes are impacting your quality of life or the health of your relationships, you should talk to your oncology team. If your feelings are severe, you may need to seek immediate assistance.

    Important Points About Taking Steroids

    As with most cancer treatment medications, it is very important to take steroids exactly as your doctor describes. Here are some good questions to ask your healthcare team about your steroids before you start:

    • How long will I be expected to take this medication?
    • Who can I contact if I have a serious reaction to this medication?
    • What if I miss a dose? (Don't simply take an extra dose of the medication).
    • What if I vomit my medication?
    • What side effects do you usually see with this particular medication both with short term and with long term use?

    Avoid Abrupt Discontinuation of Steroids

    As noted earlier, taking steroid medications has an impact on how much natural steroid your body produces. For this reason, when your steroids are no longer needed as part of your therapy, your doctor will often taper the dose off instead of stopping them abruptly. It is extremely important that you do not stop taking this medication unless you are told to by your doctor. In rare instances, stopping steroids abruptly can result in life threatening adrenal crisis.

    Even if you are following a tapering schedule, let your doctor know if your symptoms become bothersome. Some people have to be tapered off of these medications very slowly over a period of weeks or even months.

    Bottom Line on Steroids in Cancer Treatment

    Steroids are the unsung heroes of cancer care. While chemotherapy, radiation therapy, and especially the newer targeted therapies and immunotherapy get all the praise for killing cancer, steroids work quietly behind the scenes, preventing and minimizing complications and even making other therapies work better. That is why they play a big role in the treatment of both blood related cancers and solid tumors.

    That said, these drugs do have a significant number of short and long term side effects, some of which can be serious. Make sure to ask questions and talk about any symptoms you are experiencing, even if it is "only" fatigue. Be your own advocate in your cancer care.

    Sources:

    Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

    Leppert, W., and T. Buss. The Role of Corticosteroids in the Treatment of Pain in Cancer Patients. Current Pain and Headache Reports. 2012. 16(4):307-13.

    Matsuo, N., Morita, T., Matsuda, Y. et al. Predictors of Responses to Corticosteroids for Anorexia in Advanced Cancer Patients: A Multicenter Prospective Observational Study. Supportive Care in Cancer. 2017. 25(1):41-50.

    Matsuo, N., Morita, T., Matsuda, Y. et al. Predictors of Delirium in Corticosteroid-Treated Patients with Advanced Cancer: An Exploratory, Multicenter, Prospective, Observational Study. Journal of Palliative Medicine

    Mori, M., Shirado, A., Morita, T. et al. Predictors of Response to Corticosteroids for Dyspnea in Advanced Cancer Patients: A Preliminary Multicenter Prospective Observational Study. Supportive Care in Cancer. 2017. 25(4):1169-1181.

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