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 PMID 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 - PMID 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 PMID 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