I hope this is right forum for this - if not please move
Mum is on crizotinib for stage 4 lung cancer, it had stabilised lung and liver and bone mets, but brain mets found and she had 5 sessions wbr. She has been on dexamethasone for over a month now 8mg/day at first but they reduced this after she complained about feeling woozy and cloudy in her brain and she's now on 3mg (it's been about 3 weeks since radiotherapy finished).
In the last few days I've noticed a significant change in her personality: before she was woozy and took time to process thoughts or speak but now she's incredibly anxious, almost manic (keeps clasping her hands, saying 'oh dear' over and over) some of it is understandable anxiety about money and disease but some of it seems illogical- she keeps saying she can't explain what she's worried about, that she can't make us understanding. She has periods of hyperventilating although she is able to calm down eventually.
I wanted to call her team the other day but she wouldn't let me, she says she's not going to take anything that will make her feel cloudy again (steroids; sedatives) but I am really worried. I don't know at what point it's appropriate for me to go against what she wants and just call them.
Do you think this might be a reaction to lowering the steroids, or is it the brain mets?
I am worried in case they have reduced dexamethasone too early.
Please help
Thank you
Reply # - July 6, 2013, 06:23 PM
Reply To: Behavioural changes: a reaction to steroids, brain
To be honest, it can be very hard to tell, and by that I mean impossible. Seeing neurologic symptoms develop or reappear as the dose of steroids is decreased is pretty common, related to tapering too quickly, and can be treated by bumping the dose up again. But steroids themselves can cause agitation and mood changes. It's most appropriate to do this with the involvement of a patients's own medical team, but the way we often determine whether it's from a deficit or excess of steroids is by making changes and seeing what improves or worsens. Particularly in the setting of cutting back on the steroids, we would often push back up and then see how symptoms change, but that obviously requires the patient's cooperation and should really be done only with the involvement of the doctor(s) overseeing the care of that patient.
Good luck.
-Dr. West