Systemic Corticosteroids for Cancer-Related Fatigue in Advanced Cancer: A Systematic Review and Meta-Analysis.

Abstract

Cancer-related fatigue (CRF) impacts the quality of life of patients with advanced cancer. Systemic corticosteroids are often used empirically to alleviate CRF. We aimed to assess the efficacy and safety of systemic corticosteroids in alleviating CRF in adult patients with advanced cancer. We searched Medline (Ovid), the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to 22 October 2024. Randomized controlled trials assessing systemic corticosteroids in adults with CRF who were no longer candidates for curative treatments were included. Primary outcomes were CRF and any adverse events. Data were pooled using a random-effects model and certainty of evidence was assessed using the GRADE approach. The protocol was registered on PROSPERO (CRD42020194253). Six studies involving 379 participants were included, comprising four placebo-controlled trials and two active-controlled trials. Compared with placebo, use of systemic corticosteroids was associated with reduced CRF (standardized mean difference [SMD] -0.41; 95% confidence interval [CI] -0.82 to -0.00; low certainty), improved global health status (SMD 0.34; 95% CI 0.05 to 0.63; low certainty) and reduced appetite loss (SMD -0.37; 95% CI -0.72 to -0.03; low certainty), without any significant adverse events (risk ratio 1.17; 95% CI, 0.44 to 3.13; low certainty). Systemic corticosteroids may reduce CRF and may increase global health status and appetite in patients with advanced cancer, with no significant increase in adverse events, albeit with low certainty of all evidence.