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Provider views on perioperative steroid use for patients with newly diagnosed pediatric brain tumors

  • Clinical Study
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Abstract

Purpose

Cerebral edema from brain tumors can cause neurological impairment. Steroids treat edema but with possible adverse effects. We surveyed providers regarding steroid use in newly diagnosed patients with brain tumors to determine if practices are standard or markedly variable.

Methods

An anonymous voluntary online survey was sent to members of neuro-oncology consortiums. Four clinical scenarios were provided and questions regarding initiation of steroids, type, dose, formulation, and duration were asked. Demographic information was collected.

Results

369 providers received the survey, 76 responded (20.6% response rate). The proportion of providers who would start steroids significantly differed among scenarios (scenario 1 vs 2, p < 0.001; 2 vs 3, p < 0.001; 1 vs 3, p < 0.001). 75 (98.7%) providers would start steroids for vasogenic edema (scenario 1) and 55 (72.4%) for obstructive hydrocephalus (scenario 2). 16 (21.1%) would start steroids for vasogenic edema but not obstructive hydrocephalus. The odds of choosing to start steroids in patients with obstructive hydrocephalus were 7.59 times more (95% CI: 2.29, 25.13) if providers felt symptoms would improve within 24 h. All would use dexamethasone. A significant difference was seen between the proportion of providers who would give a loading dose if vasogenic edema with neurological deficits were noted versus vasogenic edema alone (57.9% vs 43.4%; p = 0.002).

Conclusions

These results suggest that providers recommend dexamethasone for patients with vasogenic edema and obstructive hydrocephalus. Variability remains with dosing schedule. Further studies are needed to identify the most appropriate use of steroids for newly diagnosed CNS tumor patients with the goal to create steroid management guidelines.

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Neurology and Developmental Neurosciences, Texas Children’s Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030 (FM), USA

    Fatema Malbari

  2. Dan L. Duncan Institute for Clinical & Translational Research, Baylor College of Medicine, One Baylor Plaza, Suite 100D, Houston, TX, 77030 (KAS), USA

    Kristen A. Staggers & Charles G. Minard

  3. Department of Neurosurgery, Baylor College of Medicine, 6701 Fannin Street, Suite 1230, Houston, TX, 77030 (HLW), USA

    Howard L. Weiner

  4. Department of Pediatrics, Division of Pediatric Hematology and Oncology, Texas Children’s Hospital/Baylor College of Medicine, 6621 Fannin St, Suite 1510.15, Houston, TX, 77030 (MC), USA

    Murali M. Chintagumpala

  5. Division of Pediatric Hematology/Oncology and Marrow and Blood Cell Transplantation, Children’s Hospital At Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Room 968, Bronx, NY, 10467 (ASL), USA

    Adam S. Levy

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  1. Fatema Malbari
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Correspondence to Fatema Malbari.

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Malbari, F., Staggers, K.A., Minard, C.G. et al. Provider views on perioperative steroid use for patients with newly diagnosed pediatric brain tumors. J Neurooncol 147, 205–212 (2020). https://doi.org/10.1007/s11060-020-03416-9

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  • DOI: https://doi.org/10.1007/s11060-020-03416-9

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