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

¹ Palliative Care Services, Stockholms Sjukhem Foundation and Department of Oncology and Pathology, Karolinska Institute, Stockholm
² 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,
³ Palliative Care Services, Stockholms Sjukhem Foundation, Stockholm, and Department of Oncology and Pathology, Karolinska Institute, Stockholm

^* To whom correspondence should be addressed.

	Abstract

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

First published on January 19, 2009, doi:10.1177/0269216308101486

Palliative Medicine 2009;23:165.

A more recent version of this article appeared on March 1, 2009


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