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Hagan AJ, Kumar R. The Utility of Methylphenidate for Fatigue in Long-Term Neurological Conditions: A Meta-analytical Review. Clin Neuropharmacol 2023; 46:239-252. [PMID: 37962311 DOI: 10.1097/wnf.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Fatigue is a chronic and debilitating symptom of many long-term neurological conditions (LTNCs). Although methylphenidate provides some promise in alleviating fatigue in other clinical groups, little work has explored its potential utility within LTNCs. The current systematic review and meta-analysis evaluates the utility of methylphenidate for symptoms of fatigue in LTNCs. METHODS Five databases (PsycINFO, MEDLINE, Embase, Scopus, and Cochrane Library) were searched for relevant articles from their inception to February 2022. A purpose-developed evaluation tool was used to assess each study's research quality (QuEST:F). RESULTS Of the 1698 articles identified, 11 articles were included within this review (n = 370). Meta-analytical findings reported an overall significant benefit of methylphenidate for symptoms of fatigue across a mixed neurological sample ( g = -0.44; 95% confidence interval, -0.77 to -0.11). Subgroup analyses identified a significantly greater benefit ( P < 0.001) of methylphenidate for fatigue in LTNCs with static pathogenic trajectories (eg, traumatic brain injury) (number needed to treat = 2.5) compared with progressive conditions (eg, multiple sclerosis) (number needed to treat = 40.2). CONCLUSIONS Methylphenidate may pose an effective intervention for the treatment of fatigue in a number of LTNCs. Nonetheless, given the quality of the current evidence base, there exists a clear need for further robust assessment of the utility of methylphenidate-with a focus on subgroup-specific variability.
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Affiliation(s)
- Alexander James Hagan
- Department of Health Psychology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne
| | - Ram Kumar
- CYP Neuro LLP, Liverpool, Merseyside, United Kingdom
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Andersen L, Meghani S, Ulrich C, McHugh M, Deng J. Coping Skills Interventions for Fatigue in Adults with Hematologic Malignancies: A Systematic Review. Am J Hosp Palliat Care 2023; 40:183-201. [PMID: 35524400 PMCID: PMC9637237 DOI: 10.1177/10499091221095531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Persons with hematologic malignancies have a high symptom burden throughout the illness journey. Coping skills interventions effectively reduce fatigue for other cancer patients. The purpose of this systematic review is to identify if coping interventions can reduce fatigue in patients with hematologic malignancies. Methods: A search of PubMed, Embase, CINAHL, APA Psych INFO, Scopus, Cochrane, and non-traditional publications was performed in June 2021 for studies introducing coping interventions for adults with hematological cancers within the past 20 years. The Transactional Model of Stress and Coping was used as a framework with fatigue as the primary outcome. The Johns Hopkins Nursing Evidence Based Practice Appraisal tool was used for quality appraisal. Results: Twelve interventional studies met criteria for inclusion. Four studies significantly reduced fatigue, with an additional 3 showing a reduction in fatigue. Interventions that utilized both problem and emotion-focused coping were more effective at reducing fatigue compared to interventions that only used emotion or problem-focused coping. Conclusion: This systematic review found moderate-strength evidence to support that coping interventions can reduce fatigue, with mixed, but mostly beneficial results. Clinicians caring for patients with hematologic malignancies should consider using coping interventions to reduce fatigue.
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Affiliation(s)
- Lucy Andersen
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Salimah Meghani
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Connie Ulrich
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Molly McHugh
- University of Pennsylvania, School of Nursing,New Courtland Center for Transitions and Health
| | - Jie Deng
- University of Pennsylvania, School of Nursing
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3
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Rau KM, Shun SC, Hung SH, Chou HL, Ho CL, Chao TC, Liu CY, Lien CT, Hong MY, Wu CJ, Tsai LY, Jane SW, Hsieh RK. Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment. Jpn J Clin Oncol 2022; 53:46-56. [PMID: 36354095 PMCID: PMC9825724 DOI: 10.1093/jjco/hyac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. METHODS To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. RESULTS Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. CONCLUSIONS These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.
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Affiliation(s)
| | | | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City, Taiwan,Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan,School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-Service General Hospital, Taipei, Taiwan,Division of Oncology, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Oncology and Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Transfusion Medicine, Department of Medicine and Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Ting Lien
- Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Ying Hong
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan,Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Li-Yun Tsai
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Sui-Whi Jane
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ruey-Kuen Hsieh
- For reprints and all correspondence: Ruey-Kuen Hsieh, Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei, Taiwan. No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan. E-mail:
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Rogal SS, Hansen L, Patel A, Ufere NN, Verma M, Woodrell CD, Kanwal F. AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology 2022; 76:819-853. [PMID: 35103995 PMCID: PMC9942270 DOI: 10.1002/hep.32378] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Shari S. Rogal
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania, USA
| | - Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Nneka N. Ufere
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Manisha Verma
- Department of Medicine, Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Christopher D. Woodrell
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Fasiha Kanwal
- Sections of Gastroenterology and Hepatology and Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Chepke C, Jain R, Rosenberg R, Moline M, Yardley J, Pinner K, Kumar D, Perdomo C, Filippov G, Atkins N, Malhotra M. Improvement in fatigue and sleep measures with the dual orexin receptor antagonist lemborexant in adults with insomnia disorder. Postgrad Med 2022; 134:316-325. [DOI: 10.1080/00325481.2022.2049553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, PA, Huntersville, NC, USA
| | - Rakesh Jain
- Texas Tech University School of Medicine – Permian Basin, Midland, TX, USA
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Helde Frankling M, Klasson C, Björkhem-Bergman L. Successful Strategies and Areas of Improvement-Lessons Learned from Design and Conduction of a Randomized Placebo-Controlled Trial in Palliative Care, 'Palliative-D'. Life (Basel) 2021; 11:life11111233. [PMID: 34833109 PMCID: PMC8619948 DOI: 10.3390/life11111233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Clinical trials in palliative care are challenging to design and conduct. Burden on patients should be minimized, while gatekeeping by professionals and next-of kin needs to be avoided. Clinical deterioration due to disease progression affects attrition unrelated to intervention, and different care settings complicate comparisons and reduce the generalizability of the results. The aim of this review is to provide advice for colleagues planning to perform clinical trials in palliative care based on our own experiences from performing the Palliative-D study and by a thorough literature review on this topic. The Palliative-D study was a double-blind trial with 244 randomized patients comparing the effect of vitamin D3 to placebo in patients with advanced or metastatic cancer in the palliative phase of their disease trajectory who were enrolled in specialized palliative home care teams. Endpoints were opioid and antibiotic use, fatigue, and QoL. Recruitment was successful, but attrition rates were higher than expected, and we did not reach targeted power. For the 150 patients who completed the study, the completeness of the data was exceptionally high. Rather than patient reported pain, we choose the difference in the mean change in opioid dose between groups after twelve weeks compared to baseline as the primary endpoint. In this paper we discuss challenges in palliative care research based on lessons learned from the "Palliative-D" trial regarding successful strategies as well as areas for improvement.
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Affiliation(s)
- Maria Helde Frankling
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Solna, SE-171 64 Stockholm, Sweden
- Correspondence:
| | - Caritha Klasson
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo Floor 7, SE-141 83 Huddinge, Sweden; (C.K.); (L.B.-B.)
- Stockholms Sjukhem, Palliative Medicine, Mariebergsgatan 22, SE-112 19 Stockholm, Sweden
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Kowalczyk L, Deutschmann C, Crevenna R, Konrad S, Singer CF, Farr A. Radiotherapy-Induced Fatigue in Breast Cancer Patients. Breast Care (Basel) 2020; 16:236-242. [PMID: 34248464 DOI: 10.1159/000509410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific side effect are diverse. Summary Prevalence, duration, and severity of radiotherapy-induced fatigue are dependent on the type of radiotherapy, as well as on the irradiated volume, dose scheme, on the number of radiation fields, the combination with other treatments, diurnal rhythm, smoking, and time-to-hospitalization. Recommended treatments include non-pharmacologic interventions, such as physical and psychosocial interventions. Pharmacologic therapies include treatment with methylphenidate and modafinil. In addition to its early detection with standardized instruments, adequate education to breast cancer patients about risks and predisposing factors of radiotherapy-induced fatigue is essential. Multidimensional strategies help to maintain the patients' quality of life and therefore guarantee treatment adherence and efficacy. Key Messages Radiotherapy-induced fatigue is an underreported, underdiagnosed, and undertreated side effect. This review provides an overview of radiotherapy-induced fatigue in breast cancer patients receiving adjuvant radiotherapy.
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Affiliation(s)
- Lidia Kowalczyk
- Clinical Unit of Anesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Konrad
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Christian F Singer
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Alex Farr
- Department of Obstetrics and Gynecology, Division of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria
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8
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Schreiner N, Perazzo J, Digennaro S, Burant C, Daly B, Webel A. Associations between symptom severity and treatment burden in people living with HIV. J Adv Nurs 2020; 76:2348-2358. [PMID: 32643309 DOI: 10.1111/jan.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
AIM To examine the association between symptoms severity and treatment burden in people living with HIV. DESIGN Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross-sectional study examining physical activity patterns. METHODS We analysed data from 103 men and women using self-report data collected between March 2016 - February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS-29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire-13. RESULTS Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task-specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task-specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms. CONCLUSION Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression. IMPACT People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self-management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self-management of HIV and other co-morbid conditions.
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Affiliation(s)
- Nathanial Schreiner
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | | | - Sarah Digennaro
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Christopher Burant
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Barbara Daly
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
| | - Allison Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA
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Ingham G, Urban K. How Confident Are We at Assessing and Managing Fatigue in Palliative Care Patients? A Multicenter Survey Exploring the Current Attitudes of Palliative Care Professionals. Palliat Med Rep 2020; 1:58-65. [PMID: 34223457 PMCID: PMC8241319 DOI: 10.1089/pmr.2020.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Fatigue is a common and significant problem for palliative care (PC) patients, affecting up to 80% of patients. Health care professionals (HCPs) commonly underestimate its significance and lack the confidence in how to manage it, resulting in poor quality of life. It is currently not known how PC professionals manage fatigue in clinical practice or what the barriers to implementation are. Objective: To determine the current attitudes of HCPs toward fatigue management in patients with a life-limiting illness. Design/Setting: An electronic survey, created on REDCap, was distributed to all staff working directly with PC patients in both the community and inpatient setting within the Sydney Local Health District. The study duration was for four weeks (May 1-30, 2018). Results: Participants recognized that fatigue is common, but only 58.5% recognized that severe fatigue is more distressing than pain. A total of 77.2% of participants do not find fatigue an easy symptom to manage and less than half (46.9%) feel confident assessing and managing it. There was no consistent systematic approach to management although exercise, education, and pacing/energy conservation were recognized as important interventions. Themes identified as potential barriers to management included lack of resources, poor patient and staff understanding, and patient/disease factors. Conclusions: HCPs lack confidence in assessing fatigue and completing an individualized management plan; the approaches adopted are highly variable. This justifies the need for further education, as well as further research assessing the efficacy of a multimodal intervention and a guideline to assist in management.
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Affiliation(s)
- Gemma Ingham
- Department of Palliative Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Katalin Urban
- Department of Palliative Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
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10
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Currow DC, Agar MR, Phillips JL. Role of Hospice Care at the End of Life for People With Cancer. J Clin Oncol 2020; 38:937-943. [DOI: 10.1200/jco.18.02235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer. Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient’s death compared with people who did not have access to these services. Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.
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Affiliation(s)
- David C. Currow
- University of Technology Sydney, Ultimo, NSW, Australia
- University of Hull, Hull, United Kingdom
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
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Abstract
BACKGROUND Cardiac toxicity in patients with cancer results from treatment-related damage to the cardiovascular system by chemotherapy, targeted agents, or thoracic radiation. Cardio-oncology patients with co-occurring cancer and cardiovascular disease frequently experience fatigue. Exercise is recommended in clinical guidelines to manage fatigue during or after cancer treatment. PURPOSE The purpose of this article is to conduct a scoping review of the exercise randomized clinical trials in cardio-oncology patients, focusing on the components and effects of exercise interventions on patient cardiovascular and fatigue outcomes. METHODS A scoping review methodological framework was deemed appropriate and used. Key words for search included "cancer," "oncology," "cardio-oncology," "heart failure," "physical activity," and "exercise." Search involved systematic searches of large databases (PubMed, MEDLINE, Cochrane Review, and CINAHL) and hand searches of reference lists, key journals, webpages, and experts in the field using snowballing techniques. RESULTS There were 12 randomized clinical trials included in this review. Study characteristics, accordance of exercise protocols with recommendations, specific exercise training components, and cardiovascular and fatigue outcomes were mapped. CONCLUSIONS Recommendations for addressing the gaps included focusing on non-breast-cancer patients with cardiac toxicity risks, developing precision-based prescriptions based on various medical and physiological characteristics, and adding fatigue symptom experience as an outcome variable.
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12
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Roji R, Stone P, Ricciardi F, Candy B. Placebo response in trials of drug treatments for cancer-related fatigue: a systematic review, meta-analysis and meta-regression. BMJ Support Palliat Care 2020; 10:385-394. [PMID: 32046962 PMCID: PMC7691807 DOI: 10.1136/bmjspcare-2019-002163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is one of the most distressing symptoms experienced by patients. There is no gold standard treatment, although multiple drugs have been tested with little evidence of efficacy. Randomised controlled trials (RCTs) of these drugs have commented on the existence or size of the placebo response (PR). The objective of this systematic review was to establish the magnitude of the PR in RCTs of drugs to relieve CRF and to identify contributing factors. METHOD RCTs were included in which the objective was to treat CRF. A meta-analysis was conducted using the standardised mean change (SMC) between baseline and final measurement in the placebo group. To explore factors that may be associated with the PR (eg, population or drug), a meta-regression was undertaken. Risk of bias was assessed using the revised Cochrane tool. RESULTS From 3916 citations, 30 relevant RCTs were identified. All had limitations that increased their risk of bias. The pooled SMC in reduction in fatigue status in placebo groups was -0.23 (95% confidence intervals -0.42 to -0.04). None of the variables analysed in the meta-regression were statistically significant related to PR. CONCLUSION There is some evidence, based on trials with small samples, that the PR in trials testing drugs for CRF is non-trivial in size and statistically significant. We recommend that researchers planning drug studies in CRF should consider implementing alternative trial designs to better account for PR and decrease impact on the study results.
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Affiliation(s)
- Rocio Roji
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, University College London, London, UK
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13
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Grassi L, Nanni MG, Rodin G, Li M, Caruso R. The use of antidepressants in oncology: a review and practical tips for oncologists. Ann Oncol 2019; 29:101-111. [PMID: 29272358 DOI: 10.1093/annonc/mdx526] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The use of psychotropic drugs, namely those with an antidepressant profile (ADs), is a mandatory part of an integrated treatment of psychiatric disorders among cancer patients. We aimed to synthetize the most relevant data emerging from published studies to provide tips about the use of ADs in oncology. Design A search was made of the major databases over the last 30 years (Embase/Medline, PsycLIT, PsycINFO, the Cochrane Library), including narrative reviews, systematic reviews and meta-analyses summarizing the results from observational studies and randomized clinical trials assessing effectiveness, safety profile, interactions, contraindications and use of ADs in oncology with regard to both psychiatric (depressive spectrum, stress-related, anxiety disorders) and cancer-related symptoms (e.g. pain, hot flashes and fatigue). Results The weight of evidence supports the efficacy of ADs for more severe major depression in individuals with cancer and as an adjuvant treatment in cancer-related symptoms, although the methodological limitations of reported randomized controlled trials do not permit definite conclusions. Data also indicate that there should be caution in the use of ADs in cancer patients in terms of their safety profile and potential clinically significant interactions with other prescribed medications. Practical recommendations that have been made for the use of ADs in cancer patients, in the context of a multimodal approach to depression treatment, have been summarized here. Conclusions ADs are a relatively safe and effective treatment for more severe major depression in cancer patients. However, more research is urgently needed regarding the efficacy of ADs in different cancer types and cancer settings, their interactions with anticancer agents and their additive benefit when integrated with psychosocial interventions.
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Affiliation(s)
- L Grassi
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - M G Nanni
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - G Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Supportive Care, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - M Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Supportive Care, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - R Caruso
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, S. Anna University Hospital and Health Authorities, Ferrara, Italy
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14
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Auricular acupressure: reducing side effects of chemotherapy in women with ovarian cancer. Support Care Cancer 2019; 27:4155-4163. [DOI: 10.1007/s00520-019-04682-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/28/2019] [Indexed: 01/25/2023]
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15
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Raikhelson KL, Kondrashina EA. Ademethionine in the treatment of fatigue in liver diseases: a systematic review. TERAPEVT ARKH 2019; 91:134-142. [DOI: 10.26442/00403660.2019.02.000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Fatigue has a significant effect on the condition of patients with liver disease. Ademethionine is considered one of the most promising drugs for its treatment. Aim. To systematize the published data on the treatment of hepatogenic fatigue with аdemethionine. Materials and methods. Search was performed using databases PubMed, EMBASE, Embase®, Medline®, eLIBRARY.ru, published in 1952-2018. Results and discussion. 16 articles were found on the use of ademethionine in liver diseases and the assessment of the dynamics of the symptom of fatigue, including 1 double-blind, randomized, placebo-controlled study, 3 open randomized studies; most of the works were multicenter open observation programs. The studies included 3238 patients (of which 2820 were included in the final data analysis) and a wide range of liver diseases: alcoholic liver disease, nonalcoholic fatty liver disease, primary biliary cholangitis, primary sclerosing cholangitis, cirrhosis of different causes, viral hepatitis, drug-induced liver injury. Different doses, routes of administration of аdemethionine and the duration of the course were used. Conclusions. Ademethionine, regardless of the route of administration, is effective in the treatment of fatigue due to different liver disease in the short and long term. The dose-dependent effect of the drug and the possibility of maintaining post-effect after end of the treatment course should be assumed, but this requires further study in randomized clinical trials.
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16
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Undiagnosed cardiac deficits in non-small cell carcinoma patients in the candidate population for anti-cachexia clinical trials. Support Care Cancer 2018; 27:1551-1561. [DOI: 10.1007/s00520-018-4561-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/19/2018] [Indexed: 01/06/2023]
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17
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Shewan LG. Contemporary publication patterns in the Journal of Cachexia, Sarcopenia and Muscle by type and sub-speciality: facts and numbers. J Cachexia Sarcopenia Muscle 2018; 9:1192-1195. [PMID: 30697979 PMCID: PMC6351672 DOI: 10.1002/jcsm.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Louise G. Shewan
- Sydney Medical SchoolUniversity of SydneySydneyNew South Wales2006Australia
- University of MelbourneParkvilleVictoria3010Australia
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18
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Almada AL, Casquinha P, Cotovio V, Santos MJHD, Caixeiro A. The Potential Role of Psychosocial Rehabilitation in Palliative Care. J R Coll Physicians Edinb 2018; 48:311-317. [DOI: 10.4997/jrcpe.2018.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an approach to incurable and/or severe disease with limited prognosis, aiming to relieve the suffering and improve the quality of life of patients and their families. The existence of psychopathology is common in patients undergoing palliative care, and psychiatric comorbidities, such as depression and anxiety, are frequent and often underdiagnosed. This work constitutes a review of the literature and a reflection on the potential role of psychosocial rehabilitation in mental health in palliative care. Psychosocial rehabilitation may play a role in the mental health of patients undergoing palliative care, contributing to the minimisation of symptoms, support in daily life activities, the improvement of quality of life and the preparation for death.
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Affiliation(s)
- AL Almada
- Psychiatric resident (5th year), Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - P Casquinha
- Psychiatrist, Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - V Cotovio
- Psychiatrist and Psychotherapist, Clinical Director of the Psychiatric Hospital, Casa de Saúde do Telhal, Sintra, Portugal
| | - MJ Heitor dos Santos
- Psychiatrist, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Portugal
- Psychiatrist, Instituto de Saúde Ambiental Faculdade de Medicina, Universidade de Lisboa, Portugal
- Head of the Psychiatry and Mental Health Department of Hospital Beatriz Ângelo, Loures, Portugal
| | - A Caixeiro
- Psychiatrist, Head of the Rehabilitation Unit in Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
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Abstract
PURPOSE OF REVIEW Despite recent advances in the care of patients with advanced non-small cell lung cancer (NSCLC), significant morbidity and mortality remains. Symptoms caused by the cancer and its treatments can be profoundly debilitating. Palliative care aims to reduce this burden. In this review, we discuss the definition, purpose, benefits, and optimal timing of palliative care in advanced NSCLC. RECENT FINDINGS Several studies evaluating the value of early palliative care for patients with advanced NSCLC and other advanced malignancies have identified benefits for patients, caregivers, and health systems. For patients with advanced NSCLC, introduction of palliative care early in the disease course improves quality of life and even overall survival. Early institution of palliative care should become standard of care for patients with advanced NSCLC.
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Affiliation(s)
| | - Scott K Dessain
- Lankenau Institute for Medical Research, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Tracey L Evans
- Lankenau Cancer Center, PA, Wynnewood, USA.
- Lankenau Institute for Medical Research, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
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20
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Modarresi A, Eslami K, Kouti L, Hassanvand R, Javadi M, Sayyah M. Amantadine reduces persistent fatigue during post-acute withdrawal phase in methamphetamine abstained individuals: A randomized placebo-controlled trial. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1459904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Atieh Modarresi
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Eslami
- School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Kouti
- School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Hassanvand
- School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Javadi
- Clinical Pharmacy Department, Faculty of Pharmacy and Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Sayyah
- Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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21
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Reich M, Bondenet X. Place des psychotropes en oncologie. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Affiliation(s)
- Nicole Ebner
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in LodzMedical University of LodzPoland
| | - Stefan D. Anker
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) partner site Berlin; Charité Universitätsmedizin BerlinBerlinGermany
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
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23
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Shangyan H, Kuiqing L, Yumin X, Jie C, Weixiong L. Meta-analysis of the efficacy of modafinil versus placebo in the treatment of multiple sclerosis fatigue. Mult Scler Relat Disord 2018; 19:85-89. [DOI: 10.1016/j.msard.2017.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/17/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
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24
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von Haehling S. Casting the net broader to confirm our imaginations: the long road to treating wasting disorders. J Cachexia Sarcopenia Muscle 2017; 8:870-880. [PMID: 29168628 PMCID: PMC5700431 DOI: 10.1002/jcsm.12256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 12/12/2022] Open
Abstract
Wasting embraces muscle and tissue wasting in sarcopenia and cachexia. This article describes recent advances in the field published in the Journal of Cachexia, Sarcopenia and Muscle concerning diagnostic tools, biomarker development, pathophysiology, and treatment. Studies discussed herein embrace those on sarcopenia and cachexia in heart failure, chronic obstructive pulmonary disease, and cancer including also animal models.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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25
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Abstract
Introduction Cachexia is a common complication of many and varied chronic disease processes, yet it has received very little attention as an area of clinical research effort until recently. We sought to survey the contemporary literature on published research into cachexia to define where it is being published and the proportion of output classified into the main types of research output. Methods I searched the PubMed listings under the topic research term "cachexia" and related terms for articles published in the calendar years of 2015 and 2016, regardless of language. Searches were conducted and relevant papers extracted by two observers, and disagreements were resolved by consensus. Results There were 954 publications, 370 of which were review articles or commentaries, 254 clinical observations or non-randomised trials, 246 original basic science reports and only 26 were randomised controlled trials. These articles were published in 478 separate journals but with 36% of them being published in a core set of 23 journals. The H-index of these papers was 25 and there were 147 papers with 10 or more citations. Of the top 100 cited papers, 25% were published in five journals. Of the top cited papers, 48% were review articles, 18% were original basic science, and 7% were randomised clinical trials. Discussion This analysis shows a steady but modest increase in publications concerning cachexia with a strong pipeline of basic science research but still a relative lack of randomised clinical trials, with none exceeding 1000 patients. Research in cachexia is still in its infancy, but the solid basic science effort offers hope that translation into randomised controlled clinical trials may eventually lead to effective therapies for this troubling and complex clinical disease process.
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26
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Ribeiro SMDF, Braga CBM, Peria FM, Martinez EZ, Rocha JJRD, Cunha SFC. Effects of zinc supplementation on fatigue and quality of life in patients with colorectal cancer. EINSTEIN-SAO PAULO 2017; 15:24-28. [PMID: 28444084 PMCID: PMC5433302 DOI: 10.1590/s1679-45082017ao3830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 01/05/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of oral zinc supplementation on fatigue intensity and quality of life of patients during chemotherapy for colorectal cancer. Methods A prospective, randomized, double-blinded, placebo-controlled study was conducted with 24 patients on chemotherapy for colorectal adenocarcinoma in a tertiary care public hospital. The study patients received zinc capsules 35mg (Zinc Group, n=10) or placebo (Placebo Group, n=14) orally, twice daily (70mg/day), for 16 weeks, from the immediate postoperative period to the fourth chemotherapy cycle. Approximately 45 days after surgical resection of the tumor, all patients received a chemotherapeutic regimen. Before each of the four cycles of chemotherapy, the Functional Assessment of Chronic Illness Therapy-Fatigue scale was completed. We used a linear mixed model for longitudinal data for statistical analysis. Results The scores of quality of life and fatigue questionnaires were similar between the groups during the chemotherapy cycles. The Placebo Group presented worsening of quality of life and increased fatigue between the first and fourth cycles of chemotherapy, but there were no changes in the scores of quality of life or fatigue in the Zinc Group. Conclusion Zinc supplementation prevented fatigue and maintained quality of life of patients with colorectal cancer on chemotherapy.
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Affiliation(s)
| | | | - Fernanda Maris Peria
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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27
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Cancer-Related Fatigue: What You Need to Know. Arch Phys Med Rehabil 2017; 98:1717-1718. [DOI: 10.1016/j.apmr.2016.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 11/20/2022]
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28
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Chang YD, Smith J, Portman D, Kim R, Oberoi-Jassal R, Rajasekhara S, Davis M. Single Institute Experience With Methylphenidate and American Ginseng in Cancer-Related Fatigue. Am J Hosp Palliat Care 2017; 35:144-150. [PMID: 28299946 DOI: 10.1177/1049909117695733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown. AIM The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy. METHODS We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents. RESULTS We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue (cutoff value: ≥3; reduction in fatigue score from baseline: 80% ≥2, 60% ≥3, and 46.7% ≥4). CONCLUSION In our retrospective medical record review, the combination treatment of methylphenidate and AG had no discernible associated toxicities and showed potential clinical benefit in CRF.
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Affiliation(s)
- Young D Chang
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Joshua Smith
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Diane Portman
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Richard Kim
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Ritika Oberoi-Jassal
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sahana Rajasekhara
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Mellar Davis
- 2 Palliative Medicine, Geisinger Medical Center, Danville, PA, USA
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29
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Frailty and Primary Sarcopenia: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1020:53-68. [DOI: 10.1007/5584_2017_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Mücke M, Mochamat, Cuhls H, Peuckmann‐Post V, Minton O, Stone P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review. J Cachexia Sarcopenia Muscle 2016; 7:23-7. [PMID: 27066315 PMCID: PMC4799864 DOI: 10.1002/jcsm.12101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases. METHODS We considered randomized controlled trials concerning adult palliative care with a focus on pharmacological treatment of fatigue compared with placebo, application of two drugs, usual care or a non-pharmacological intervention. The primary outcome had to be non-specific fatigue (or related terms such as asthenia). We searched the CENTRAL, MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. Two review authors independently assessed trial quality and extracted the data. RESULTS We screened 1645 publications of which 45 met the inclusion criteria. In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials. Meta-analysis of data was possible for modafinil, pemoline, and methylphenidate. CONCLUSIONS Due to the limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Some drugs, which may be beneficial for the treatment of fatigue associated with palliative care such as amantadine, methylphenidate, and modafinil, should be further researched.
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Affiliation(s)
- Martin Mücke
- Department of Palliative MedicineUniversity Hospital BonnBonnGermany
- Department of General Practice and Family MedicineUniversity Hospital BonnBonnGermany
- Center for Rare Diseases Bonn (ZSEB)University Hospital of BonnBonnGermany
| | - Mochamat
- Department of Palliative MedicineUniversity Hospital BonnBonnGermany
- Department of Anesthesiology and Intensive TherapyUniversity of Diponegoro/Kariadi HospitalJawa TengahIndonesia
| | - Henning Cuhls
- Department of Palliative MedicineUniversity Hospital BonnBonnGermany
| | | | - Ollie Minton
- Division of Mental HealthSt George's University of LondonLondonUK
| | - Patrick Stone
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryLondonUK
| | - Lukas Radbruch
- Department of Palliative MedicineUniversity Hospital BonnBonnGermany
- Centre for Palliative CareMalteser Hospital Seliger Gerhard Bonn/Rhein‐SiegBonnGermany
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