Journal CME August 2024, Steroid myopathy and rehabilitation in patients with cancer-PM R - 2024 - Tsetlina

PM R - 2024 - Tsetlina - Steroid myopathy and rehabilitation

Pdf Summary

This comprehensive review examines steroids and their usage in oncology, especially focusing on glucocorticosteroid-induced myopathy (SM), a condition first documented in 1932. While steroids are commonly used for their therapeutic benefits, they also pose significant risks, particularly for patients with cancer, such as those with brain tumors or undergoing hematopoietic stem cell transplants. Despite the prevalence of SM, no standardized guidelines exist for its diagnosis and treatment.<br /><br />The review combines a narrative overview of SM's etiology, pathogenesis, diagnosis, symptoms, and treatment options with a scoping review on exercise therapies for SM. The pathology involves steroid hormones binding to glucocorticoid receptors, leading to muscle breakdown through catabolic processes and reduced protein synthesis. Clinically, SM presents as progressive, painless muscle weakness, often affecting proximal muscles and respiratory function.<br /><br />The incidence of SM in cancer patients is reported between 10% to 60%, influenced by factors like steroid dosages, duration of treatment, and underlying health conditions. Children are notably vulnerable to additional steroid side effects, such as impaired growth and cognitive changes.<br /><br />Diagnostic challenges persist due to the non-specificity of certain tests. Muscle biopsies, while useful, are invasive and thus not routinely performed. Non-invasive methods, like quantitative ultrasound and dynamometry, show promise in monitoring muscle quality and strength changes.<br /><br />There is no widely accepted pharmacological treatment for SM. Current strategies emphasize minimizing steroid exposure and exploring dietary and anabolic steroid interventions. Exercise has shown potential in mitigating SM's effects, with endurance and resistance training being beneficial according to both human and animal studies. However, high-intensity exercises may exacerbate the condition.<br /><br />The conclusion stresses the need for controlled clinical trials to validate these findings and develop tailored therapeutic strategies, especially for the pediatric population. Early detection and targeted rehabilitation, including personalized exercise regimens, may mitigate functional degeneration and improve life quality for patients facing this debilitating condition.

Keywords

steroids

oncology

glucocorticosteroid-induced myopathy

cancer

diagnosis

treatment

exercise therapy

muscle weakness

clinical trials

pediatric