Radiation Oncology/Fatigue

Fatigue Most frequent symptom in advanced cancer patients No data exist about frequency of fatigue in different tumors Etiology is unclear; autonomic failure has been implicated Management includes treatment of reversible causes (e.g. mood disorders, anemia) No pharmacologic trials have shown improvement in cancer-related fatigue Anti-cholinergics Donepezil (Aricept) MD Anderson; 2007 17687152 -- "Donepezil for cancer fatigue: a double-blind, randomized, placebo-controlled trial." (Bruera E, J Clin Oncol. 2007 Aug 10;25(23):3475-81.) Randomized. 103/142 patients with fatigue score >=4 (scale 0-10) for more than 1 week. Treated with 1) donepezil 5mg x 7days vs. 2) placebo. Everyone donepezil open label second week Outcome: No difference by FACIT-F or ESAS Conclusion: No difference from placebo Psychostimulants Methylphenidate (Ritalin) MD Anderson; 2006 - 16648508 — "Patient-Controlled Methylphenidate for Cancer Fatigue: A Double-Blind, Randomized, Placebo-Controlled Trial." Bruera E et al. JCO May 1 2006: 2073–2078. Randomized to 5 mg methylphenidate q2h as needed (patient controlled) vs placebo. No significant difference from placebo. Antidepresants Paroxetine (Paxil) Rochester; 2003 14673053 -- "Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program." (Morrow GR, J Clin Oncol. 2003 Dec 15;21(24):4635-41.) Randomized. 479/549 patients undergoing chemo for the first time, and reported fatigue at their 2nd cycle. Treated with 1) oral paroxetine 20mg qd x8 weeks vs. 2) placebo Outcome: No difference in fatigue between groups; but benefit in depression score Conclusion: No impact on fatigue