Steroids: A guide for patients with breast cancer

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What are steroids?

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

How can steroids help with breast cancer?

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

When might I be prescribed steroids?

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

How do I take steroids?

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.

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.

What are the possible side effects of 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.

What is a steroid card?

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.

What will happen when I stop taking steroids?

Your body will begin making its own natural steroids again slowly after you have stopped taking steroids, although this can take a few days to happen.

If the steroid tablets you have been taking are suddenly stopped, you may experience withdrawal effects including:

• Temperature above 37.5ºC
• Aches in muscles or bones
• Feeling generally unwell
• Painful, itchy skin nodules
• Weight loss

The dose you take will be gradually reduced to lower the risk of withdrawal effects.

What are the side-effects of steroids in long term use?

These are some of the symptoms that can develop with long term use of steroids and include:

• Eye problems: increased risk of eye infections, worsening of glaucoma, or can cause cataracts
• Changes in appearance: acne, facial puffiness, facial hair (in women), or dark marks on the skin
• Weaker muscles: you may notice it is more difficult to undertake everyday activities. Keeping as active as you feel you can, can help
• Bone thinning (osteoporosis): your doctor may wish to prescribe ‘bone strengthening’ drugs
• Interruptions to menstrual cycle: your period may become irregular. It is advisable not to become pregnant while taking steroids.

Important points to remember:

• You must not stop taking your tablets unless your doctor tells you to. If you are unable to take your tablets due to sickness, or take too many, please seek advice from GP or Nurse Specialist
• Steroids should be reduced gently and not stopped suddenly. Make sure you have a good supply at home so you do not run out of tablets
• Always carry your steroid card with you
• Inform your doctor, dentist, pharmacist and nurse that you are taking steroids
• Do not take a double dose if you forget to take your tablets

Useful contacts

Please contact your Breast Cancer Nurse Specialist or your GP if you require further support or information.