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Patient-Controlled
Methylphenidate for the Management of Fatigue in Patients With Advanced Cancer:
A Preliminary Report
Eduardo Bruera,
Larry Driver, Elizabeth A. Barnes, Jie Willey, Loren Shen, J. Lynn Palmer,
Carmelita Escalante
From the
Departments of Palliative Care and Rehabilitation Medicine, Anesthesiology,
General Internal Medicine, and General Internal Medicine, The University of
Texas M.D. Anderson Cancer Center, Houston, TX; and the Toronto-Sunnybrook
Regional Cancer Center, Toronto, Canada.
Address
reprint requests to Eduardo Bruera, MD, Department of Palliative Care and
Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center,
Unit 8, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: ebruera@mdanderson.org.
Purpose.
To assess the effects of patient-controlled methylphenidate for
cancer-related fatigue.
Patients and Methods.
In this prospective open study, 31 patients with advanced cancer and
fatigue who scored  4 on
a scale of 0 to 10 received methylphenidate 5 mg by mouth every 2
hours as needed for 7 days (maximum, 20 mg/d).
Multiple symptoms were assessed daily; the primary end point,
fatigue, was measured using the 0 to 10 scale, and the Functional
Assessment for Chronic Illness Therapy–Fatigue (FACIT-F) was
performed at baseline, day 7, and day 28.
Results.
The following mean (± standard deviation) scores for 30 assessable
patients improved significantly between baseline and day 7: fatigue
(0 to 10 scale), 7.2 ± 1.6 v 3.0 ± 1.9 (P < .001);
overall well-being (0 to 10 scale), 4.5 ± 2.2 v 2.8 ± 2.1 (P
< .001); fatigue (FACIT-F) subscore, 17.5 ± 11.3 v 34.7 ±
10.0 (P < .001); functional well-being, 14.4 ± 5.9 v
18.3 ± 6.6 (P < .001); and physical well-being, 13.5 ±
6.4 v 21.4 ± 5.0 (P < .001).
Anxiety, appetite, pain, nausea, depression, and drowsiness all
improved significantly (P < .05).
All patients took afternoon or evening doses, and 28 patients (93%)
took three or more doses daily.
All patients chose to continue taking methylphenidate after 7 days of
treatment.
No serious side effects were reported.
Conclusion.
These preliminary results suggest that patient-controlled methylphenidate
administration rapidly improved fatigue and other symptoms.
Randomized controlled trials are justified.
Presented in part at
the 39th Annual Meeting of the American Society of Clinical Oncology,
Chicago, IL, June 2, 2003.
© 2003
American
Society for Clinical Oncology
Source: http://www.jco.org/cgi/content/abstract/21/23/4439?etoc
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