How do steroids work?

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

In medicine, we use artificial steroids called corticosteroids when the body cannot make its own. This is known as steroid replacement. Sometimes, we use steroids as medicine delivered in higher doses. Available as pills, creams and injections, manufactured steroids help break fevers, bring down inflammation and reduce pain. 

Here, I’ll explain more about steroids, including how they work, if they cause side effects and how they’re used in cancer treatment.

What is the main function of steroids? 

Inflammation is your body's natural response to an event, like trying to heal a wound or fight an infection. Both of these are good things, but they can sometimes cause pain. Steroids can help bring down inflammation and, in turn, help manage some types of pain.

How are steroids used in cancer treatment?

Steroids have multiple roles in cancer treatment.

They can be used as part of the cancer treatment itself, such as with some leukemias, lymphomas and multiple myeloma.

Steroids are also used to help manage the side effects of cancer treatment.

They’re very effective at treating nausea and vomiting related to chemotherapy. During immunotherapy, sometimes the immune system will react by damaging some of the patient’s organs. We might prescribe steroids to resolve that autoimmune damage. Additionally, we may prescribe steroids if a patient has a tumor that is causing swelling of the brain or spinal cord.

To get clear images during a CT scan, radiologists use a contrast dye, 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.

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. We’ve seen that a small dose of steroids can help boost energy in patients. Steroids don't affect the cancer, but they can help improve your energy level as you're going through cancer treatment.

Steroids can also help boost your appetite if you don’t feel like eating during cancer treatment.

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

The length and strength of a steroid prescription depend on your 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. Similarly, if you are experiencing swelling in the brain, we’ll prescribe a high-dose steroid. Usually, high doses of steroids are given for a short time.

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.

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. This may cause sugar levels to rise, which is important if you have diabetes. 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. However, this is rare.

Steroids increase your appetite and may result in weight gain. Steroids can cause bone weakness and accelerate osteoporosis. They can also increase your blood pressure.   

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

Fortunately, most side effects from steroids improve rapidly when you can slowly decrease the dose, and later stop taking them.

What else should we know about steroids?

You should never stop taking steroids on your own without consulting with your doctor. This is because the steroids are blocking our adrenal glands from making steroids naturally. So, essentially they stop working for a while. If you suddenly stop taking the steroids, the adrenal glands will not have enough time to start making the steroids our body needs, which could lead to serious problems. It’s best to wean yourself off of steroids. Always check with your doctor to decide if at any time it's necessary to reduce the dose or to stop taking steroids. Your doctor will advise you on the safest way to do this. 

Remember, steroids have been used in cancer care for decades. We’re 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 decide on whether adding a steroid is right for you.

Eduardo Bruera, M.D., is chair of Palliative Care, Rehabilitation and Integrative Medicine at MD Anderson.

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