Long term use of corticosteroids can be associated with significant morbidity, including development of glucocorticoid-induced osteoporosis and resultant fractures, leading to increased pain and disability. There are currently no specific standards or guidelines pertaining to the use of bone protection in patients on long term corticosteroids in palliative care. However, given that a significant proportion of palliative care patients are on corticosteroids for prolonged periods, this is an area that should be explored further.Standards
Standards used were the American College of Rheumatology 2010 Recommendations for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. These guidelines recommended for this cohort that patients on long term glucocorticoid treatment (dose ≥7.5 mg prednisolone daily for ≥ three months) should be on bone protection therapy (bisphosphonate).Methodology
Retrospective audit using chart review of patients with primary intracranial tumours on initial referral to Palliative Care Team.Results
Initially 39 eligible patients identified. On manual review of these charts, 32 were eligible, n=32. 37.5% were on steroids on admission, and had been on steroids for > three months on initial assessment and had greater than three months to live. 12.5% had > six months to live and were on steroids on first assessment, and 6.25% had been on >3 month course of steroids.Conclusions
62% patients who were initially assessed by palliative care team should have been considered for bone protection therapy prior to referral. 45% of patients were not suitable for consideration for bone protection treatment. This leaves 55% which could have potentially been considered for bone protection therapy by the palliative team following initial assessment.