Jiang, Z., Butler-Bowen, H., Rodriguez, T., Garcon, M.C., Smith, M.H., Relias, V., & Saif, M.W. (2016). Role of methylphenidate in the treatment of fatigue in advanced pancreatic cancer population. Annals of Gastroenterology, 29, 536–543.

DOI Link

Study Purpose

To assess the effects of methylphenidate (MPH) in ameliorating fatigue in patients with advanced pancreatic cancer

Intervention Characteristics/Basic Study Process

Records of patients with stage 4 pancreatic cancer who were experiencing fatigue were retrospectively analyzed. The fatigue level was assessed at each visit prior to chemotherapy, and a trial of MPH was done for at least four weeks. MPH was begun at 5 mg by mouth daily and increased to 10 mg for those who did not benefit from the lower dose.

Sample Characteristics

  • N = 71   
  • AGE RANGE = 38–76 years
  • MALES: 57.7%, FEMALES: 42.3%
  • CURRENT TREATMENT: Chemotherapy

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: United States

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Palliative care

Study Design

Retrospective

Measurement Instruments/Methods

  • Visual analog scale-fatigue (VAS-F)
  • Numeric scale

Results

Most patients continued MPH after four weeks, for up to 24 months. Fatigue improved at least from grade 3 to grade 2, or from grade 2 to grade 1 in 55%; and in 23%, fatigue resolved. Fourteen percent stopped MPH because of lack of benefit, and 13% stopped because of adverse effects. The most common adverse effects were weight loss, nausea, anorexia, and insomnia.

Conclusions

MPH appeared to provide some benefit in reducing fatigue for some patients but had important negative side effects in others.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Subject withdrawals ≥ 10% 
  • States use of VAS, but data reported appear to be from a 10-point numeric scale.  
  • No statistical analysis was conducted.

Nursing Implications

The findings regarding any potential benefit of psychostimulants, such as MPH, for the management of cancer-related fatigue have been mixed. MPH has also been associated with a number of adverse side effects. Nurses need to be aware of side effects and relevant monitoring if MPH is used.