Glucocorticosteroids in Palliative Care: Between Common Clinical Practice and Limited Scientific Evidence: A Scoping Review

Background/Objectives: Glucocorticosteroids (GCS) are widely used in palliative care for established indications such as cerebral edema or spinal cord compression as well as for nonspecific symptoms including fatigue, appetite loss and weight loss. However, evidence supporting many symptomatic indications remains limited, while treatment-related adverse effects may significantly affect patient functioning. This scoping review aimed to map the evidence on systemic GCS use in palliative care, focusing on indications, symptomatic benefits, dosing and duration, adverse effects, monitoring and discontinuation. Methods: A scoping review was conducted according to Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR. PubMed, Scopus, Web of Science, and the Cochrane Library were searched up to September 2026 without date restrictions. English-language publications involving adults with advanced or life-limiting disease were eligible if they addressed systemic GCS use for symptom management or palliative complications. Data on indications, treatment regimens, outcomes, adverse effects, and discontinuation were charted and synthesized descriptively. Results: The evidence comprised clinical studies, randomized controlled trials (RCTs), observational studies, systematic and narrative reviews, clinical guidelines and case reports. Evidence was heterogeneous and indication-dependent. Established indications were supported primarily by clinical guidelines and clinical experience, despite limited comparative evidence, whereas evidence for nonspecific symptoms was generally limited or inconsistent. Hyperglycemia, myopathy, neuropsychiatric effects, and osteoporosis were among the clinically relevant adverse effects, particularly with prolonged or higher-dose treatment. Conclusions: Systemic GCS therapy in palliative care should be individualized according to indication, expected benefit, prognosis, and treatment burden. A time-limited “trial of steroids” with predefined therapeutic goals, duration, and regular reassessment of benefit and adverse effects may provide a structured approach to symptomatic treatment. Further research is needed to define optimal dosing, monitoring and discontinuation strategies.