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The existential impact of starting corticosteroid treatment as symptom control in advanced metastatic cancer

Palliative Care Services, Stockholms Sjukhem Foundation and Department of Oncology and Pathology, Karolinska Institute, Stockholm

CJ Fürst

Palliative Care Services, Stockholms Sjukhem Foundation and Department of Oncology and Pathology, Karolinska Institute, Stockholm

M Friedrichsen

Palliative Education and Research Center, Unit of Palliative care, Vrinnevi Hospital, Norrköping and Department of Social and Welfare Studies, Faculty of Health Sciences, Campus Norrköping, Linköping University, Linköping,

P Strang

Palliative Care Services, Stockholms Sjukhem Foundation, Stockholm, and Department of Oncology and Pathology, Karolinska Institute, Stockholm

Treatment with corticosteroids often results in increased appetite, reduced nausea and improved well-being in patients with advanced metastatic cancer. Therefore, we have studied the existential impact of starting corticosteroid treatment as symptom control in this patient group using qualitative content analysis with both a descriptive and an interpretative focus. Ten patients were interviewed before and after 1 week of treatment with 4 mg betamethasone. Prior to treatment, patients reported distressing symptoms, deterioration and diminished autonomy, symbolising threat and death. Corticosteroid treatment produced symptom relief in the majority of the patients. They reported enhanced physical abilities and experienced feelings of a more normalized life and strengthened autonomy, symbolising health and hope. This transfer from threat to hope has important existential consequences in end-of-life care and should be addressed when communicating goals of treatment and care with the patient and family.

Key Words: cancer • corticosteroids • existential • palliative care • qualitative

This version was published on March 1, 2009

Palliative Medicine, Vol. 23, No. 2, 165-170 (2009)
DOI: 10.1177/0269216308101486


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