Steroid therapy is often used within treatment regimens for lymphoma. Steroids are also used for the treatment of lymphoma.
What are steroids?
Steroids are hormones that are made naturally in the body. A type of steroid used is corticosteroids and our bodies make corticosteroids in the adrenal glands. The adrenal glands are located just above the kidneys.
Corticosteroids have an important role in:
- Metabolism (the digestion of food to get energy)
- Controlling the balance of salt and water in your body
- Regulating your blood pressure
- Fighting infection (immunity)
- Reducing inflammation (swelling) and allergic reactions
- Regulating your mood
When steroids are used for people with cancer, they are made in a laboratory. The types of corticosteroids most often used to treat lymphoma are called prednisolone, methylprednisolone, and dexamethasone.
Why are steroids used in lymphoma?
Steroids are used for several reasons in the treatment of lymphoma.
These can include:
- Treat the lymphoma itself
- Help other treatments such as chemotherapy to work better
- Reduce allergic reactions to other drugs
- Improve side-effects like fatigue, nausea, and poor appetite
- Reduce swelling to relieve pressure, for example if you have spinal cord compression
How are steroids given?
Steroids can be given in several different ways.
They can be given:
- In tablet form or as a liquid you can drink.
- Intramuscularly (by an injection into a muscle, usually in your thigh)
- Intravenously (into a vein), through a cannula or central line (a thin, plastic tube)
- Topically (directly onto the skin) as an ointment or cream.
- They are usually given in short courses. It is important to make sure you know how long you need to take them for.
What are the side-effects of steroids?
Steroids can cause several side effects. In most cases side-effects caused by steroids go away within a couple of days after you stop taking them.
Common side-effects include:
- Stomach upsets
- Increased appetite and weight gain
- Increased blood pressure
- Osteoporosis
- Increased blood sugar- increased thirst, frequent urination, high blood glucose and high levels of sugar in the urine
- Fluid retention
- Increased risk of infection
- Mood swings
- Insomnia and sleep
- disturbances
- Myopathy
Mood and behaviour changes
Steroids can affect mood and behaviour. They can cause:
- feelings of anxiety or restlessness
- mood swings (moods that go up and down)
- low mood or depression.
Sometimes, when taken in higher doses, steroids can cause confusion or changes in thinking. This can include having strange or frightening thoughts.
Tell the doctor or nurse if there are any changes in mood or behaviour. There may be some changes to treatment if side effects are causing problems.
Tips for taking steroids
Steroids can cause several side effects that can affect normal daily function and mood. Ways to help reduce some of these side effects can include:
- Take steroids in the morning to try to avoid sleep problems at night (steroids can make some people hyperactive and unable to relax for sleep)
- Take steroids with milk or food to prevent stomach upset
- Report any signs of infection to your doctor and nurse – a high temperature, cough, swelling or any inflammation.
- Advise the patient to monitor for signs of fluid problems such as shortness of breath or difficulty breathing, swelling of feet or lower legs, or rapid weight gain.
- Tell your medical team if you have any side-effects that are bothering you.
- Take all tablets as instructed. Make sure you take the correct dose and do not stop taking steroids suddenly or without your doctor’s advice. If you miss a tablet, check with your doctor about what you should do.
- Depending on the dose and the length of time on the medication, the doctor will advise how to slowly reduce the dose (taper the dose) over a few days to prevent low mood.
Special precautions
Some medicines could interact with steroid medications and change the effect of both. Check with the doctor about what medications can be taken or not.
Examples are:
- inflammation, such as ibuprofen
- indigestion, such as antacids
- high blood pressure
- heart problems
- tuberculosis
- diabetes
- seizures
- blood clotting, for example blood thinning drugs such as warfarin.
Live vaccinations
Patients should not have live vaccines (which contain weakened, live bacteria or viruses) whilst on steroids or for 6 months afterwards.
Live vaccines include those given to protect against:
- chickenpox
- measles, mumps, and rubella (MMR)
- polio
- shingles
- tuberculosis (BCG vaccine)
Pregnancy and breastfeeding
It is not advisable to become pregnant, or to father a child, whilst on steroids or for a few months afterwards. This is because steroids can harm the development of an unborn baby.
If you are breastfeeding, speak to a member of the medical team for advice specific to the type and dose of steroids. The general advice is to avoid breastfeeding for around 3 to 4 hours after each dose of steroids, to allow time for the steroids crossing into the breast milk to reduce minimal levels. This is apart from topical steroids when there is no need to wait before breastfeeding.
Infection risk
Avoid contact with people who have chickenpox or shingles, even if you have had these infections in the past – they could be serious if you have lymphoma and are on steroids. Tell the doctor straight away if you think you could have chicken pox or shingles.
