Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction

To determine the effect of dexamethasone when treating malignant bowel obst ruction, 35 patients were randomized to receive intravenous dexamethasone o r a placebo, crossing over to the alternate treatment arm if there had been no resolution of obstruction by day 5. This was done in two consecutive st udies. Patients were stratified according to whether or not they had receiv ed specific anticancer therapy within 28 days of study. In trial 1, 15 out of 22 patients 'responded' (resolution of obstruction by day 5; 10 on dexam ethasone, five on placebo). Eleven out of 15 patients were 'on treatment'. In trial 2, six out of 13 responded (three on dexamethasone, three on place bo); three out of six were 'on treatment'. When both studies are combined, 60% (21/35) patients responded (13 on dexamethasone, eight on placebo). Poo r patient accrual terminated both studies. Numbers are too small to allow a combination of studies or formal statistical analysis. We are unable to ma ke any conclusion as to the effectiveness of dexamethasone in the palliatio n of malignant bowel disease.