Corticosteroids for Anorexia-Cachexia and Asthenia Syndrome in Palliative Care: A Scoping Review

Anorexia–cachexia–asthenia syndrome (ACAS) is a common, distressing problem in palliative care that impairs comfort, function and quality of life. Corticosteroids are frequently used in practice, but their efficacy, duration of benefit and safety—especially medium- and long-term—remain unclear. We conducted a scoping review following Joanna Briggs Institute guidance and reported per PRISMA-ScR. This study was not prospectively registered in an international database. We searched PubMed/MEDLINE, Scopus, Web of Science and the Cochrane Library for original articles published between 2001 and 2025 in English, Spanish or Portuguese. We included randomized trials and observational studies assessing corticosteroid use for anorexia, fatigue/asthenia or cachexia in adults receiving palliative care. Data were charted in a standardized template and synthesized narratively. After screening and full-text assessment, 18 studies (total N ≈ 6306) were included; most were observational, and populations and regimens were heterogeneous. 13/18 studies reported improved appetite, 10/18 reported improved fatigue/asthenia, and only 1/18 used objective cachexia measures. Dexamethasone and methylprednisolone were the most commonly evaluated agents. Corticosteroids produced rapid improvements in appetite and, to a lesser extent, fatigue—often within 48–72 hours—but benefits were generally short-lived, commonly waning after 2–4 weeks. Evidence for sustained effects on cachexia or objective muscle mass was limited; most studies reported weight or appetite changes without objective muscle-mass assessment. Reported harms included hyperglycemia/worsening glycemic control, fluid retention/edema, neuropsychiatric effects (insomnia, mood changes, agitation, delirium), steroid-induced muscle weakness and increased infection risk, particularly with prolonged use. We conclude that corticosteroids may offer useful, short-term symptomatic relief for anorexia and fatigue in palliative care but should be used judiciously, individualized, and for limited periods with close monitoring for metabolic, neuropsychiatric and infectious adverse effects. Future research should prioritize dose-finding randomized trials, objective cachexia measures, and multimodal interventions to extend benefit.