Background: Fatigue is a common and distressing symptom in palliative care patients. It remains challenging to manage effectively. Current evidence regarding management is scarce and often extrapolated from the survivorship population. The Rapid program offers a highly valid, “real-world” methodology to accurately characterise the use, efficacy, and adverse effect profile of dexamethasone for the management of fatigue. 

Objective: To explore the use, efficacy, and side effect profile of dexamethasone for fatigue management.

 

Method: This international, prospective case series involved 8 sites across Australia, New Zealand, and the UK. Benefits and harms were assessed at baseline (commencement of dexamethasone) (T0)  and 5-7 days post-baseline (T1). Adverse events were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 5. Higher scores indicate worse symptoms. Fatigue was also assessed using the Fatigue Severity Scale (FSS) and the Symptom Assessment Scale for fatigue (SAS). The Related Samples Wilcoxon Signed Rank Test was used to compare before and after scores.

Results: Data for 18 patients with a median age of 70 years (IQR 61-83) were collected. Patients had advanced metastatic cancer, most commonly lung cancer (39%).  The majority (94%) were given a daily dose of dexamethasone via the oral route (89%). CTCAE Fatigue scores were reduced from 3 to 2.5 (P=0.18). FSS scores increased from 3 to 5 (P=0.126). Median SAS scores decreased from 7 to 5.5 (P=0.007) implying a significant reduction in distress from fatigue. 

The most common harms included agitation (42%), depression (33%), increased appetite or weight gain (33%), and delirium (25%). At T1, 17% of patients had ceased dexamethasone, 25% had a dose reduction , and 58% continued on their current dose . No patients ceased dexamethasone due to harms. 

Conclusion: Our preliminary results demonstrate an improvement in fatigue scores over time from baseline to T1.