How do steroids work?

Steroids are a natural part of your body. They’re hormones that help regulate your body’s reaction to infection or injury, the speed of your metabolism and more. 

In medicine, we can use artificial steroids called corticosteroids to help break fevers, bring down inflammation and reduce pain. Available as pills, creams and injections, manufactured steroids help us better control the amount in your body and take advantage of their healing qualities.

Despite commonly being used in a range of medical situations, there are a lot of misconceptions about steroids. How do they work? Can you have too much? And are there side effects?

To help explain steroids’ benefits and risks, and learn how they’re used in cancer treatment, we talked with Ishwaria Subbiah, M.D.

What are steroids used to treat? How are they used in cancer treatment?

Inflammation is your body naturally responding to an event, whether it is trying to heal a wound or fight an infection. Both of those are good things, but they can sometimes cause pain. Steroids can help bring down inflammation and in turn can help manage pain.

In cancer treatment, steroids have multiple roles. First, they’re sometimes a part of the cancer treatment itself, such as with some lymphomas and multiple myeloma.

Second, they’re very effective at bringing down nausea and vomiting related to chemotherapy.

They can also play a role with CT scans, which take images of your body to locate cancer for initial diagnosis as well as throughout treatment to see how the cancer is responding. To get clear images, a contrast dye is used, but some patients are allergic to it. Steroids can help control that allergy so that patients can safely get the contrast dye and undergo CT scans.

In addition, MD Anderson research has shown that steroids can help ease cancer-related fatigue, which is different from the tiredness you may feel after a long day. Typically, your energy level is much lower than it was previously, and you can't really pinpoint one cause. We’ve seen that a small dose of steroids can help boost energy to where patients can have a better quality of life. It’s important to note that in the case of treating fatigue, steroids aren’t affecting the cancer, but they’re a valuable tool to help improve your energy level as you're going through cancer treatment.

How do you decide what dose of steroids to give to a patient?

The length and strength of a steroid prescription depends on the situation. If you’re gasping for air due to asthma or COPD, we’ll give very high-dose steroids because your lungs and the airways are inflamed. Struggling to breathe can be life-threatening, so we want to bring that down quickly with that high dose.

However, if you’re experiencing cancer-related fatigue, we prescribe a lower dose of steroids that you may take once or twice a day for a short period of time to help improve your quality of life.

Or, if you have an endocrine dysfunction because of a problem with your pituitary gland or the adrenal gland, you may need to take replacement steroids by mouth for the rest of your life.

Do steroids have side effects?

Yes, steroids can affect many aspects of your body’s function. For example, steroids can change how your body maintains sugar levels and the levels rise, which is important if you have diabetes. At MD Anderson, we work with our endocrinology team or your primary care doctor who manages your diabetes to adjust the doses of your diabetes medications, so your diabetes is still being managed while you’re on steroids.

Steroids can also cause cognitive changes. Most commonly, they can make you feel more active, or even euphoric. If you end up taking your steroid dose later in the day, they can keep you awake at night and impact your sleep/wake cycle. Steroids can also cause confusion, especially in older patients and when given in high doses for long periods. This is called steroid psychosis. Patients may have more jumbled thoughts or speech, not recognize their surroundings or be more agitated.

Also, steroids increase your appetite and may result in weight gain. Steroids impact the health of your bones and muscles, too, which can be a problem if you’re on steroids for a long period of time.   

Swelling, especially in the legs and in the face, can also occur in patients on steroids for a long period of time.

But steroids have been a part of cancer care for decades. We’re very aware of the effects related to these drugs, and we know how to manage them. As with all medications, your medical team always considers the risks versus the benefits of including a steroid as a part of your cancer care. Working together, you can make a decision on whether adding a steroid is right for you.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.