Background
Systemic corticosteroids lead to many adverse effects
especially in cancer patients. Preventive measures and
treatment options are essential to minimise such side
effects.
Objectives
The aims of the study included the evaluation
of the prescribers’ management of corticosteroid
induced hyperglycaemia, dyspepsia, oral candidiasis
and proximal myopathy, the discussion of possible
reasons for non-adherence to guidelines, and the
recommendation of interventions to reduce their risk
of occurrence.
Method
A retrospective review of the medical records for 156
consecutive patients at oncology out-patients and in
oncology wards of Boffa Hospital between the 1st and the
14th September 2014 was performed. Only patients who
were on long term corticosteroids (>2 weeks’ duration)
were considered. Patients younger than 12 years of
age or those that were prescribed corticosteroids for
antiemetic purposes were excluded from the study. For
each of the sampled patients, any management aimed
at reducing corticosteroid side effects was compared
to the guidelines as stated in an article published in a
prominent international journal.
Results
From 156 cancer patients, 55 patients satisfied
the inclusion criteria. The mostly addressed side
effect was dyspepsia (n=35; 63.6%) followed by
proximal myopathy (n=27; 49%), hyperglycaemia
(n=24; 43.6%) and lastly oral candidiasis (n=20; 36%). Adherence to guidelines was as follows:
hyperglycaemia – haemo-glucose test (HGT) and
glycated haemoglobin (HbA1c) (36%); dyspepsia -
prescribing of omeprazole (51%) and ranitidine (5%);
oral candidiasis - orophargyngeal exam (29%); and
proximal myopathy (40% compliance; of which 35%
complying with resistance and endurance exercise
and 5% complying with steroid dose reduction).
Conclusion
Improvement is required with regards to the
management of corticosteroid side effects especially
for hyperglycaemia and oral candidiasis. Possible
actions that may be taken include strategies to
improve guideline awareness, the prescribing of the
lowest effective dose, adequate patient education and
the implementation of a steroid card.peer-reviewe
