Journal of Clinical Oncology, Vol 21, Issue 23
(December), 2003: 4439-4443
© 2003 American Society for Clinical Oncology
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{at}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.
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