ATP

ATP

PEP Topic 
Fatigue
Description 

Adenosine 5’-triphosphate (ATP) is a naturally occurring nucleotide present in every cell of the human body. Although ATP is known primarily for its role in intracellular energy metabolism, it also is widely distributed outside the cell. Extracellular ATP and its breakdown product, adenosine, are involved in the regulation of numerous biologic processes. ATP is the energy that drives cell activity, and energy intake from food ultimately is transformed to ATP.

Effectiveness Not Established

Research Evidence Summaries

Agteresch, H. J., Dagnelie, P. C., van der Gaast, A., Stijnen, T., & Wilson, J. H. (2000). Randomized clinical trial of adenosine 5’-triphosphate in patients with advanced non-small-cell lung cancer. Journal of the National Cancer Institute, 92, 321–328.

doi: 10.1093/jnci/92.4.321
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Intervention Characteristics/Basic Study Process:

A 30-hour infusion of adenosine 5’-triphosphate (ATP) was given every two to four weeks for 10 to 20 μg/kg/minute escalated to 75 μg/kg/minute. Regulation of biologic processes may be altered by ATP infusion to inhibit weight loss and deterioration of quality of life.

Sample Characteristics:

  • The sample included 58 patients (ATP, n = 28; control, n = 30).
  • Age and other parameters were similar.

Setting:

  • Outpatient
  • The Netherlands

Study Design:

  • Patients were randomized to ATP versus supportive care.
  • Patients were stratified by tumor stage (IIIB or IV), prior chemotherapy versus none, and Karnofsky Performance Status (KPS) greater than 70 versus less than 70.

Measurement Instruments/Methods:

  • Rotterdam Symptom checklist (RSCL)
  • Single-item measures of tiredness and lack of energy

Results:

  • A significant benefit of ATP was observed on tiredness (p = 0.0001) and lack of energy (p = 0.001).
  • Mild, transient side effects were noted in the majority of patients.

Limitations:

  • No placebo was administered, and outcome assessors were not blinded to patients' treatment arms.
  • A control for concomitant steroids, which were given for brain edema, nausea, and dyspnea, did not exist.
  • Ethical concerns arose about giving 10 30-hour infusions every two to four weeks (requiring hospital admissions) in patients with non-small cell lung cancer with limited expected lifespans.
  • Hospitalization costs were a limitation.

Beijer, S., Hupperets, P. S., van den Borne, B. E., Wijckmans, N. E., Spreeuwenberg, C., van den Brandt, P. A., & Dagnelie, P. C. (2010). Randomized clinical trial on the effects of adenosine 5'-triphosphate infusions on quality of life, functional status, and fatigue in preterminal cancer patients. Journal of Pain and Symptom Management, 40, 520–530.

doi: 10.1016/j.jpainsymman.2010.01.023
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Study Purpose:

To investigate the effects of adenosine 5'-triphosphate (ATP) infusions on quality-of-life (QOL) parameters in patients with preterminal cancers of mixed tumor types.

Intervention Characteristics/Basic Study Process:

Patients were randomized to the usual care control group with standard nutritional advice or to the intervention of usual care, nutritional advice, and ATP infusion. An eight- to 10-hour ATP infusion was given weekly, with a maximum dose of 50 µ/kg/minute.

Sample Characteristics:

  • In total, 83 patients (23 women, 60 men) (ATP, n = 44; control, n = 39) were included.
  • Age ranged from 54 to 78 years.
  • Patients were undergoing curative treatment for lung, colon, gastrointestinal, prostate, and other types of cancer.
  • Patients reported fatigue and had weight loss greater than 5% or anorexia.

Setting:

  • The study was conducted at multiple sites in The Netherlands.
  • The initial dose was given at the daycare centers of participating hospitals and then patients were infused at home.

Study Design:

The study was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Quality of Life Questionnaire
  • Groningen Activity Restriction Scale (GARS)
  • Dutch Short Fatigue Questionnaire
  • Jamar Hydraulic Hand Dynamometer
  • MicroFET 2 Dynamometer

Results:

  • Between the ATP and control groups, no statistically significant differences were observed in QOL, functional status, or fatigue.
  • Elbow flexor muscle strength had an almost significant increase in the control group (1.98).

Conclusions:

Better survival was observed during the eight-week intervention in the ATP group. The rationale was that palliative cancer drugs cause serious side effects. The authors concluded that that may be an advantage of the ATP treatment.

Limitations:

  • The study had a small sample size, with less than 100 patients.
  • The increased drop-out may have limited the power of the study.
  • Large heterogeneity existed between patients.
  • The eight-week intervention was shorter than other studies of 12 weeks.

Nursing Implications:

The study provided little useful information for nurses.


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