Specific situations
Corticosteroids can have multiple uses in palliative care. Due to potential side effects, the minimum dose to control the symptom should be given. Dexamethasone is the steroid of choice because it causes less fluid retention. Depending on the indication, different doses are recommended:
§ Anorexia/weakness/tumour related oedema pain/improvement in wellbeing – 2-4mg daily
§ Nerve compression pain/liver capsule pain/nausea/bowel obstruction – 4-8mg daily
§ Raised intracranial pressure/superior vena cava obstruction/malignant spinal cord compression – 12-16mg daily
Steroids should be given in the morning to avoid sleep disturbance. Consideration should be given to whether gastric protection should be prescribed. Steroids should be reduced slowly every 5-7 days when appropriate.
Nutrition is always a worry for palliative patients and those close to them. Loss of appetite is a very common symptom in people with advancing incurable conditions. Calorie intake should be optimised and use of nutritional supplements and high calorie energy drinks may be required. Referral to a dietician might be appropriate. As already mentioned, dexamethasone can be used to increase appetite. If there is no response after 7-10 days, these should be stopped. In the dying patient, the burden of over feeding or over hydrating a person can often outweigh the benefits as patients might have an increased urine output or more bronchial secretions. Mouth care is often more useful to help with a dry mouth. Families will often need constant reminding and reassurance of this.