Steroids can be used as part of cancer treatment. Here we describe how they are given and some of the side effects that may occur.
You will have regular appointments with your doctor to monitor the effect of the steroids. This information should help you to discuss any queries about your treatment and its side effects with your doctor or chemotherapy nurse.
Steroids (sometimes called corticosteroids) are substances that are naturally produced in the body. They are made by the adrenal glands. There are two adrenal glands - one sits on the top of each kidney.
They help control many different functions in our bodies, like the way the body uses fats, proteins and carbohydrates. They regulate our immune system and the balance of salt and water in our bodies. They also help to reduce inflammation.
Steroids can be manufactured synthetically as drugs. There are different types of steroids and they all have different effects on the body. Common types of steroids used in cancer treatment are: hydrocortisone, dexamethasone, methylprednisolone and prednisolone.
Steroids can be used:
as part of your treatment to help destroy cancer cells and make chemotherapy more effective
to help reduce an allergic reaction to certain chemotherapy drugs
in low doses as anti-sickness drugs to improve your appetite.
In these situations, steroids are usually given only for short periods of time, and the side effects described here won’t usually occur.
What steroids look like
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Some are clear fluids used for injection.
Some are available as tablets. The colour and dose of the tablets depends on the type of steroid used.
Soluble tablets of prednisolone and a dexamethasone syrup are available for people who have difficulty swallowing.
How steroids are given
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Steroids can be given in the following ways:
As tablets, which are swallowed with plenty of water or milk. They may need to be taken at set times each day and are often given in short courses rather than continuously. It’s important to make sure you know how long you need to take them for.
By injection into a muscle (intramuscularly).
By injection through a tube (cannula) inserted into a vein, either as a quick injection, or as a drip which takes up to 30 minutes.
By injection through a central line, a tube which is inserted under the skin into a large vein near your collarbone.
By injection through a PICC line, a tube inserted into a vein in the bend of your arm near the elbow.
Possible side effects of steroids
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It is important to remember that each person’s reaction to a drug is different and some people have very few side effects. The effects will also vary according to the dose of the steroid that you are having, and may be different if you are also having other drugs.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Irritation of the stomach lining
Steroids can irritate the lining of the stomach and may cause a stomach ulcer, or make one worse. The tablets should be taken with meals or a drink of milk to help reduce this side effect. Tell your doctor if you have indigestion, stomach pains or abdominal discomfort. Some steroid tablets are coated to help reduce irritation. These are often a shiny red or brown colour.
You may be prescribed medication to reduce irritation of the stomach. You shouldn’t take any antacid medication that you have bought from your chemist without discussing it with your specialist or pharmacist first. Coated steroid tablets should not be taken at the same time as any antacids as this can dissolve the coating.
Temporary changes in blood-sugar level
This may happen if you have high-dose or long-term treatment. While having steroids, your blood-sugar levels may be checked with blood tests. You may be asked to test your urine for sugar. You’ll be shown how to do this.
If you have diabetes, you should be more careful than usual about checking your blood-sugar levels. Contact your doctor if you have any problems controlling the diabetes. And tell your doctor if you get very thirsty or are passing more urine than usual.
This can be due to a change in your salt and water balance. You may notice that your ankles and/or fingers swell. Some people have a bloated feeling in the abdomen (tummy). This is usually only a problem with long-term treatment.
Appetite changes and weight gain
You may notice that you feel hungrier than usual while taking steroids and this can make you want to eat more. If you’re concerned about gaining weight, speak to your doctor, specialist nurse or a dietitian.
Increased chance of infection and delayed healing
This happens mainly with high-dose or long-term treatment. Tell your doctor if you notice signs of infection (inflammation, redness, soreness or a temperature), or if cuts take longer than usual to heal. To help prevent infection, it's especially important to be careful about things like washing your hands.
Women may find that their periods become irregular or stop.
Behavioural changes and mood swings
Occasionally steroids can cause mood swings, difficulty sleeping, and anxiety or irritability. These effects happen mainly with high-dose or long-term treatment and will stop when the steroid therapy ends. Let your doctor know if there are any changes in your behaviour that are worrying you. Difficulty with sleeping may be helped by taking the steroids in the early part of the day, but discuss this with your doctor first.
Discomfort in your bottom
If the steroid dexamethasone is given quickly into a vein, it can cause a strange sensation in the perineal area - the area just in front of your back passage. This only lasts for a short time.
Less common side effects of steroids
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Cataracts or glaucoma may develop with long-term use of steroids. There is also an increased risk of eye infections. Tell your doctor if you notice any eye problems.
This is usually only caused by long-term use of steroids. It can cause acne, puffiness of the face, facial hair in women and dark marks on the skin. Cushing’s syndrome can be reduced a little by taking the steroids early in the morning, taking them on alternate days instead of every day or reducing the dose - but discuss this with your doctor first.
With long-term use of steroids (more than a few months), your legs may feel weaker. When the steroids are stopped, some people have muscle cramps for a short time.
Bone thinning (osteoporosis)
This may happen with long-term use of steroids (more than a few months). Let your doctor know if you have any pain in your bones, especially in the lower back.
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You’ll be given a steroid card if you have to take steroids at home. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if the steroids are just being given as a short course, such as for anti-sickness medication.
If you need to have any dental work, tell your dentist you are having steroid treatment.
If long-term steroid use is suddenly stopped, withdrawal effects can occur. For this reason, it's important to take the prescribed dose at the times recommended by your doctor. When the steroid treatment is over, the dose is gradually reduced. Your doctor will advise you on this.
Things to remember about steroid tablets
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Keep the tablets in a safe place, out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
Tell your doctor if you are sick just after taking a tablet, as you may need to take another one.
If you forget to take your tablet, do not take a double dose. Ask your doctor or nurse for advice.
If you're having a short course of steroids as part of your treatment, do not get more from your GP.
This information has been compiled using information from a number of reliable sources, including:
With thanks to Christine Clarke, Macmillan Lead Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.