Mercadante 2007.

Study characteristics
Methods	Prospective, randomised, controlled study of steroids as adjuvant drugs to opioids Study duration: 9 weeks
Participants	76 patients with advanced cancer (31 opioid, 35 dexamethasone) with pain requiring strong opioids Other co‐analgesics allowed
Interventions	Group O: conventional opioid treatment Group OS: 8 mg dexamethasone orally along with conventional treatment
Outcomes	Average daily pain intensity measured using the patient's self report on NRS from 0 (absent) to 10 (maximum) Well‐being sensation, rated by means of a NRS from 0 to 10 Symptoms associated with opioid therapy or commonly present in advanced cancer patients (nausea and vomiting, weakness, drowsiness, constipation, confusion), scale from 0 to 3 (not at all, slight, a lot, awful) Opioid escalation index percentage (OEI%) and absolute dose (OEI mg)
Notes	No difference between groups in OEI Other co‐analgesics allowed, not standardised Difference in OEI between arms at baseline
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Patients randomly divided into 2 groups Method not described
Allocation concealment (selection bias)	High risk	Method not stated
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding
Blinding of outcome assessment (detection bias) All outcomes	High risk	Not stated
Incomplete outcome data (attrition bias) All outcomes	High risk	Half of the patients died before the third week making the interpretation of any long‐term corticosteroid benefit difficult
Selective reporting (reporting bias)	Unclear risk	Authors did not specify the adverse drug reactions where they claimed symptomatic improvement except for nausea, vomiting and constipation
Other bias	High risk	Sample size: 76 participants; < 50 participants per treatment arm