• Fumiyuki Yamasaki, Kazuhiro Nakamura, Kazuhiko Sugiyama, Masao Kobayashi, and Kaoru Kurisu.
• Department of Neurosurgery, Hiroshima University, Japan.
• No Shinkei Geka. 2012 Jul 1;40(7):607-16.

ObjectivesIn the absence of guidelines on the use of corticosteroids in children with cancer and brain tumors, neurosurgeons (neurosurgical oncologists) and pediatricians administer these drugs based on their own experience. We surveyed Japanese neurosurgeons and pediatricians with regard to their policies for the use of corticosteroids in pediatric patients.MethodsThis survey was performed in November, 2010. Questionnaires designed for neurosurgeons and pediatricians were mailed to institutions registered with the Japanese Society of Pediatric Hematology (pediatricians) and to departments and hospitals providing training under the auspices of the Japan Neurosurgical Society (neurosurgeons).ResultsThe questionnaire focused on identifying the adverse effects of corticosteroids delivered for longer than 3 months to pediatric patients. Members of both specialties considered it important to avoid the development of infection, gastrointestinal ulcer, moon face/obesity, and abnormal glucose tolerance. Pediatricians but not neurosurgeons cited osteoporosis, aseptic bone necrosis, hypertension, and glaucoma as adverse effects that concerned them with respect to the prolonged administration of corticosteroids. Physicians working in high-volume centers tended to differentiate between adverse effects elicited in patients under palliative care and those receiving long-term corticosteroid treatment for other reasons; clinicians who encountered fewer patients did not.ConclusionsAs their experience of treating children with cancer increased, clinicians began to focus on quality-of-life issues raised by the administration of corticosteroids rather than the avoidance of adverse effects. This survey may help to develop guidelines regarding the use of corticosteroids in pediatric patients, especially those needing palliative care.

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