Table of ContentsView AllTable of ContentsCorticosteroids DefinedTypes of SteroidsReasons for UseCortisolSide EffectsImpact of Steroids on MoodBefore You Start TreatmentDiscontinuing Use
Table of ContentsView All
View All
Table of Contents
Corticosteroids Defined
Types of Steroids
Reasons for Use
Cortisol
Side Effects
Impact of Steroids on Mood
Before You Start Treatment
Discontinuing Use
In patients with cancer,corticosteroids, or steroids, can be a part of the cancer treatment or they might be used to help with the side effects of treatment, or even as part of a pain management program. They are very helpful, versatile medications that can be effective in a variety of settings and for many different conditions. However, as with all medications, there are side effects to know about. For example, steroids can have short-term and long-term side effects, and they might also affect your mood.
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What Are Corticosteroids?
Which Steroids Are Used in Cancer Therapy?
When we think of someone taking steroids, we often think of muscle-boundathletesor weightlifters. Recreational steroids, like the ones described above, are called anabolic steroids and are not typically used in cancer care.
Examples of these types of steroids are:
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).
Thecorticosteroid convertercan be used to compare dosages of one of these drugs to another.
Reasons for Using Steroids in Cancer Treatment
Corticosteroids may be used for a wide variety of reasons for 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. In blood cancers or hematologic malignancies, corticosteroids are often a part of a multi-drug regimen given to treat the malignancy.
Corticosteroids have been a part of many regimens for the so-called lymphoproliferative disorders, which include lymphoma. As early as the 1950s, reports of the effect of steroids in lymphoid tissue were made, and large-dose steroid therapy was at that time initially used for the management of advanced-stage lymphomas and leukemias. Today, some form of CHOP and a monoclonal antibody, rituximab, is considered a preferred treatment for intermediate and high-grade non-Hodgkin lymphoma—and the “P” in CHOP, is prednisone, a corticosteroid.
An overview of several possible uses of corticosteroids in patients with cancer follows:
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 bodies 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 (smallendocrine glandswhich sit on top of the kidneys) to release cortisol, a “natural steroid.”
Cortisol plays 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
Theside effects of steroidstend 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 “feedback 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:
Long-term side effects of steroids are common and may include:
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 healthcare provider know if you experience any symptoms or side effects.
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 healthcare provider describes. Here are some good questions to ask your healthcare team about your steroids before you start:
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 healthcare provider will often taper the dose off instead of stopping them abruptly.
Even if you are following a tapering schedule, let your healthcare provider 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.
How to Taper Prednisone
A Word From Verywell
Steroids in some ways might be thought of as 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.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ramamoorthy S, Cidlowski JA.Corticosteroids: Mechanisms of action in health and disease.Rheum Dis Clin North Am. 2016;42(1):15-31, vii. doi: 10.1016/j.rdc.2015.08.002Matsuo N, Morita T, Matsuda Y, et al.Predictors of Responses to Corticosteroids for Anorexia in Advanced Cancer Patients: a Multicenter Prospective Observational Study.J Pain Symptom Manage. 2016;52(1):64-72. doi:10.1007/s00520-016-3383-zMori M, Shirado AN, Morita T, et al.Predictors of Response to Corticosteroids for Dyspnea in Advanced Cancer Patients: A Preliminary Multicenter Prospective Observational Study.Support Care Cancer.2017;25(4):1169-1181. doi:10.1007/s00520-016-3507-5Leppert W, and Buss T.The Role of Corticosteroids in the Treatment of Pain in Cancer Patients.Current Pain and Headache Reports. 2012. 16(4):307-13. doi:10.1007/s11916-012-0273-zAdditional ReadingKasper D, Fauci AS, Hauser S. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill Education, 2015. Print.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Ramamoorthy S, Cidlowski JA.Corticosteroids: Mechanisms of action in health and disease.Rheum Dis Clin North Am. 2016;42(1):15-31, vii. doi: 10.1016/j.rdc.2015.08.002Matsuo N, Morita T, Matsuda Y, et al.Predictors of Responses to Corticosteroids for Anorexia in Advanced Cancer Patients: a Multicenter Prospective Observational Study.J Pain Symptom Manage. 2016;52(1):64-72. doi:10.1007/s00520-016-3383-zMori M, Shirado AN, Morita T, et al.Predictors of Response to Corticosteroids for Dyspnea in Advanced Cancer Patients: A Preliminary Multicenter Prospective Observational Study.Support Care Cancer.2017;25(4):1169-1181. doi:10.1007/s00520-016-3507-5Leppert W, and Buss T.The Role of Corticosteroids in the Treatment of Pain in Cancer Patients.Current Pain and Headache Reports. 2012. 16(4):307-13. doi:10.1007/s11916-012-0273-zAdditional ReadingKasper D, Fauci AS, Hauser S. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill Education, 2015. Print.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ramamoorthy S, Cidlowski JA.Corticosteroids: Mechanisms of action in health and disease.Rheum Dis Clin North Am. 2016;42(1):15-31, vii. doi: 10.1016/j.rdc.2015.08.002Matsuo N, Morita T, Matsuda Y, et al.Predictors of Responses to Corticosteroids for Anorexia in Advanced Cancer Patients: a Multicenter Prospective Observational Study.J Pain Symptom Manage. 2016;52(1):64-72. doi:10.1007/s00520-016-3383-zMori M, Shirado AN, Morita T, et al.Predictors of Response to Corticosteroids for Dyspnea in Advanced Cancer Patients: A Preliminary Multicenter Prospective Observational Study.Support Care Cancer.2017;25(4):1169-1181. doi:10.1007/s00520-016-3507-5Leppert W, and Buss T.The Role of Corticosteroids in the Treatment of Pain in Cancer Patients.Current Pain and Headache Reports. 2012. 16(4):307-13. doi:10.1007/s11916-012-0273-z
Ramamoorthy S, Cidlowski JA.Corticosteroids: Mechanisms of action in health and disease.Rheum Dis Clin North Am. 2016;42(1):15-31, vii. doi: 10.1016/j.rdc.2015.08.002
Matsuo N, Morita T, Matsuda Y, et al.Predictors of Responses to Corticosteroids for Anorexia in Advanced Cancer Patients: a Multicenter Prospective Observational Study.J Pain Symptom Manage. 2016;52(1):64-72. doi:10.1007/s00520-016-3383-z
Mori M, Shirado AN, Morita T, et al.Predictors of Response to Corticosteroids for Dyspnea in Advanced Cancer Patients: A Preliminary Multicenter Prospective Observational Study.Support Care Cancer.2017;25(4):1169-1181. doi:10.1007/s00520-016-3507-5
Leppert W, and Buss T.The Role of Corticosteroids in the Treatment of Pain in Cancer Patients.Current Pain and Headache Reports. 2012. 16(4):307-13. doi:10.1007/s11916-012-0273-z
Kasper D, Fauci AS, Hauser S. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill Education, 2015. Print.
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