Minton, O., Richardson, A., Sharpe, M., Hotopf, M., & Stone, P. (2008). A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. JNCI: Journal of the National Cancer Institute, 100, 1155–1166.
To examine the role of methylphenidate and other drugs in the management of cancer-related fatigue
DATABASES: Cochrane Register of Controlled Trials, EMBASE, and hand searching of several journals and reference lists
KEYWORDS: neoplasms or cancer or carcinoma or tumour, bone marrow transplant, neutropenia, radiotherapy, fatigue. Complete listing of search terms is provided.
INCLUSION CRITERIA:
EXCLUSION CRITERIA:
TOTAL REFERENCES RETRIEVED: Initial searching provided 5,841 articles and abstracts for screening. One hundred sixteen were reviewed in detail.
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Studies were done from 1992–2007. Data were collected from studies on a standard form by two independent reviewers, and any differences were resolved by consensus.
FINAL NUMBER STUDIES INCLUDED = 27
SAMPLE RANGE ACROSS STUDIES = 12–939
TOTAL PATIENTS INCLUDED IN REVIEW: 6,568
KEY SAMPLE CHARACTERISTICS: Samples included a variety of tumor types, a variety of treatments, and patients in active treatment as well as after treatment.
Erythropoietin
Ten trials were included in meta-analysis.
Darbepoetin
Four trials were included in meta-analysis.
Paroxetine
Two studies were included.
Progestational Steroids
Four studies were included—three with megestrol acetate and one with medroxyprogesterone acetate.
Methylphenidate
Two studies were included.
Single studies
Findings suggest that there is no overall, effective pharmacologic management of cancer-related fatigue. Meta-analysis of progestational steroids report an overall negative effect, suggesting that this approach is counterproductive for fatigue management.
The majority of patients who were treated with hematopoietic growth factors were anemic, pointing to the need to correct anemia, rather than any direct effect on the symptom of fatigue. These results point to the need to clinically evaluate such potential causes of fatigue. Even in these cases, the effect size is relatively small.