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Supportive Care in Cancer

, Volume 25, Issue 4, pp 1169–1181 | Cite as

Predictors of response to corticosteroids for dyspnea in advanced cancer patients: a preliminary multicenter prospective observational study

  • Masanori MoriEmail author
  • Akemi Naito Shirado
  • Tatsuya Morita
  • Kenichiro Okamoto
  • Yoshinobu Matsuda
  • Yoshihisa Matsumoto
  • Hirohide Yamada
  • Hiroki Sakurai
  • Etsuko Aruga
  • Keisuke Kaneishi
  • Hiroaki Watanabe
  • Takashi Yamaguchi
  • Takuya Odagiri
  • Shuji Hiramoto
  • Hiroyuki Kohara
  • Naoki Matsuo
  • Hideki Katayama
  • Tomohiro Nishi
  • Takashi Matsui
  • Satoru Iwase
Original Article

Abstract

Purpose

Although corticosteroids can relieve dyspnea in advanced cancer patients, factors predicting the response remain unknown. We aimed to explore potential factors predicting the response to corticosteroids for dyspnea in advanced cancer patients.

Methods

In this preliminary multicenter prospective observational study, we included patients who had metastatic or locally advanced cancer, were receiving specialized palliative care services, and had a dyspnea intensity of ≥3 on a 0–10 Numerical Rating Scale (NRS) (worst during the last 24 h). The primary endpoint was NRS of dyspnea on day 3 after the administration of corticosteroids. Univariate/multivariate analyses were conducted to identify factors predicting ≥1-point reduction in NRS.

Results

Of 74 patients who received corticosteroids, 50 (68%) showed ≥1-point reduction in dyspnea NRS. Factors that significantly predicted the response were an age of 70 years or older (82 vs. 53%, p = 0.008), absence of liver metastases (77 vs. 46%, p = 0.001), Palliative Prognostic Index (PPI) ≤ 6 (90 vs. 61%, p = 0.041), presence of pleuritis carcinomatosa with a small collection of pleural effusions (84 vs. 55%, p = 0.011), presence of audible wheezes (94 vs. 60%, p = 0.014), and baseline dyspnea NRS ≥7 (76% vs. 52%, p = 0.041). In a multivariate analysis, factors predicting response included PPI <6 (odds ratio (OR), 36.2; p = 0.021), baseline dyspnea NRS (worst) ≥7 (OR, 6.6; p = 0.036), and absence of liver metastases (OR, 0.19; p = 0.029) or ascites/liver enlargement (OR, 0.13; p = 0.050).

Conclusions

The patient characteristics, etiologies of dyspnea, and clinical manifestations may predict responses to corticosteroids for dyspnea. Larger prospective studies are promising to confirm our findings.

Keywords

Dyspnea Corticosteroids Predictors Cancer Palliative care 

Notes

Acknowledgments

This research in (partially) supported by the Practical Research for Innovative Cancer Control from Japan Agency for Medical Research and development, AMED (15ck0106059h0002).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Masanori Mori
    • 1
    Email author
  • Akemi Naito Shirado
    • 1
  • Tatsuya Morita
    • 2
  • Kenichiro Okamoto
    • 3
  • Yoshinobu Matsuda
    • 4
  • Yoshihisa Matsumoto
    • 5
  • Hirohide Yamada
    • 6
  • Hiroki Sakurai
    • 7
  • Etsuko Aruga
    • 8
  • Keisuke Kaneishi
    • 9
  • Hiroaki Watanabe
    • 10
  • Takashi Yamaguchi
    • 11
  • Takuya Odagiri
    • 10
  • Shuji Hiramoto
    • 12
  • Hiroyuki Kohara
    • 13
  • Naoki Matsuo
    • 14
  • Hideki Katayama
    • 15
  • Tomohiro Nishi
    • 16
  • Takashi Matsui
    • 17
  • Satoru Iwase
    • 18
  1. 1.Seirei Mikatahara General HospitalHamamatsu, ShizuokaJapan
  2. 2.Palliative and Supportive Care DivisionSeirei Mikatahara General HospitalHamamatsu City, ShizuokaJapan
  3. 3.Palliative MedicineShowa University Northern Yokohama HospitalYokohama-shi, KanagawaJapan
  4. 4.Department of Psychosomatic Internal MedicineNational Hospital Organization Kinki-Chuo Chest Medical CenterOsakaJapan
  5. 5.Department of Palliative MedicineNational Cancer Center Hospital EastKashiwa, ChibaJapan
  6. 6.Seirei Hamamatsu General HospitalHamamatsu, ShizuokaJapan
  7. 7.Department of Palliative CareCancer Institute HospitalTokyoJapan
  8. 8.Department of Palliative MedicineTeikyo University School of MedicineTokyoJapan
  9. 9.Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical CenterTokyoJapan
  10. 10.Komaki City HospitalKomaki City, AichiJapan
  11. 11.Department of Palliative MedicineKobe University Graduate School of MedicineKobe, HyogoJapan
  12. 12.Department of Oncology, Katsura Goshocho1, Nisikyo-kuMitsubishi Kyoto HospitalKyotoJapan
  13. 13.Department of Palliative CareHiroshima Prefectural HospitalHiroshimaJapan
  14. 14.Hospice, Medical Corporation Junkei-kai Sotoasahikawa HospitalAkitaJapan
  15. 15.NHO Yamaguchi-Ube Medical CenterUbe, YamaguchiJapan
  16. 16.Kawasaki Municipal Ida HospitalKawasaki-shi, KanagawaJapan
  17. 17.Department of Palliative Medicine, Tochigi Cancer CenterUtsunomiya, TochigiJapan
  18. 18.Research Hospital, The Institute of Medical ScienceThe University of TokyoTokyoJapan

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