Steroids – a guide for patients with breast cancer

Steroids occur naturally in the body in small amounts. They are needed to control a variety of functions, including the immune system and to help reduce inflammation.

Man-made steroids, also called corticosteroids, are an anti-inflammatory medication. These help to reduce swelling, and can be used as a treatment for many different conditions. They are different from anabolic steroids, which are often taken illegally to increase muscle mass.

Steroids used in cancer treatment include:

• Dexamethasone
• Prednisolone
• Methylprednisolone
• Hydrocortisone

When you have breast cancer, you can develop certain symptoms as a result of the cancer itself, or as a side effect of treatment.

There are a number of reasons you might have steroids as part of your cancer treatment.

To:

• Treat the cancer itself
• Help reduce inflammation
• Reduce your body’s immune response
• Help reduce sickness from chemotherapy
• Help improve your appetite.

• After your first diagnosis
• Before and after surgery
• Before, during and after radiotherapy
• In advanced cancer for symptom control.

Steroids can be given as an injection or in tablet form.

Dexamethasone is the steroid that is prescribed most commonly in breast cancer.

Dexamethasone tablets come in 0.5mg, 2mg and 4mg doses.

You will normally be prescribed a higher dose to begin with, which is then gradually reduced.

DO NOT STOP YOUR STEROID TABLETS SUDDENLY.

Dexamethasone should be taken with, or just after food, as it can irritate the lining of the stomach. The tablets should be swallowed whole, and taken with a glass of water or milk.

Your doctor will usually prescribe a ‘stomach protector’ medication such as Lansoprazole or Omeprazole for the course of your steroids.

• Tummy pain or indigestion.
  Steroids can irritate the lining of your stomach.
• Raised blood sugar levels.
  Your blood will be checked regularly for this. They may also test your urine for sugar.
  Symptoms of raised blood sugar include:

          - Feeling thirsty
          - Passing urine more often
          - Feeling more tired than usual.

          If you have diabetes, you may notice your blood sugars are higher than usual. Please discuss this with            your doctor as it may be necessary to adjust your diabetes medication.

• Weight gain.
  You may notice an increase in your appetite whilst you are taking steroids, so you may gain some weight.
• Fluid retention. Your fingers, feet and ankles may swell because of a buildup of fluid, although this is more common in long term use. The swelling will improve after your treatment ends. Raising your legs on to a stool or cushion can help with this.
• Increased risk of infection.
  Steroids can affect your immune system, especially if you are taking high doses or having chemotherapy at the same time. If you have any signs of infection then please contact your GP

          To help reduce the risk of getting an infection it is important to:
          - Wash your hands frequently
          - Avoid people with an infection, such as a cold
          - Avoid crowded places, where the risk is higher picking up an infection
          - Have your flu jab.

•  Mood, behaviour and sleep changes.
  Steroids can cause a change in your mood and/or behaviour and you may find you have difficulty sleeping. It may help to take your steroid tablets in the morning, or if you take them twice daily, then morning and afternoon.
  Changes in mood and behaviour include:
  - Feelings of restlessness or anxiety
  - Mood swings
  - Irritability
  - Difficulty sleeping/nightmares
  - Low mood or depression.
  If you have a history of mental health issues, including depression, please inform your doctor before starting steroids.

If you are prescribed steroids for three weeks or more then you will be provided with a steroid card. You should always carry this card with you so that if in the event of an emergency, a doctor will know that you are taking steroid medication.