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Under the prevailing COVID-19 crisis, this article is well worth reading. The current World Health Organization (WHO) guidance is not to start steroids in cancer cases, but there is no clear evidence of risks with steroids in cancer patients having COVID-19. The advice from the USA Center of Disease Control & Prevention and WHO in March 2020 was to avoid steroid treatment. This led to confusion and dilemma among medical teams. The rationale for the use of steroids is three-fold: 1) part of anti-cancer therapy; 2) supportive care; 3) to treat toxicity. The fatality rate for cancer patients with COVID-19 is nearly twice the overall fatality rate (based on data from China). Steroids are used in physiological doses (e.g. prednisolone with abiraterone for prostate cancer) and supra-physiological doses (e.g. in malignant spinal cord compression and to treat toxicity such as docetaxel-induced capillary leak syndrome). There is at present no proof that steroid therapy in cancer patients with COVID-19 should be stopped or that it is associated with worse outcomes. Of course, a risk-benefit analysis should be performed on a case to case basis. Further research and data analysis will be required.

Corticosteroids for urological cancer care during COVID-19.
Waterhouse JV, Hull JH, Linch M.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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