Johnson, R. L., Block, I., Gold, M. A., Markwell, S., & Zupancic, M. (2010). Effect of methylphenidate on fatigue in women with recurrent gynecologic cancer. Psycho-Oncology, 19, 955–958.

To evaluate the effect of methylphenidate on fatigue in women with recurrent gynecologic cancer.

Women with recurrent gynecologic cancer currently receiving chemotherapy and reporting fatigue at baseline were prescribed methylphenidate. The dose started at 5 mg taken at 8 am and noon and was titrated up to 10 mg at two weeks if the patient reported a limited response. Data were obtained at baseline and two, four, and eight weeks.

• In total, 13 women were included. 
• Average age was 59 years (range 23–87).
• All patients had recurrent gynecologic cancer:  ovary (n = 25), endometrial (n = 1), cervical (n = 1), vaginal (n = 1), sex cord endometrial (n = 1), ovary and endometrial (n = 1), and unknown histology (n = 2).
• Patients were Caucasian (n = 29), Native American (n = 1), African American  (n = 1), and unknown (n = 1); no other demographic was information available.

• Single site   
• Outpatient   
• Comprehensive cancer center in the United States; University of Oklahoma

Patients were undergoing the active treatment on chemotherapy phase of care.

The study was a prospective trial.

• Fatigue Symptom Inventory (FSI) 
• Functional Assessment of Cancer Treatment–General (FACT-G)
• Brief Symptom Inventory (BSI)

Thirty-two women were initially enrolled; only 13 completed the eight-week follow-up. Scores on the FSI decreased statistically significantly from baseline at all measurement points (week 2, p = 0.0088; week 3, p = 0.0007; week 3, p = 0.0001). BSI scores also decreased, with scores at weeks 4 and 8 significantly lower than baseline (p = 0.015 and 0.0015, respectively). There was an overall change in FACT-G scores over time (p = 0.0351), with significant change in physical well-being (p = 0.0235) and emotional well-being (p = 0.0099). There was no change in family/social and functional well-being.

Methylphenidate may be beneficial to women with recurrent gynecologic cancer experiencing treatment-related fatigue.

• The study had a small sample size, with less than 100 patients.
• The study lacked a control group.
• There was significant attrition.
• The group was very select (recurrent gynecologic cancer).
• There was one treatment site in one country.
• The study lacked racial/ethnic diversity.

Findings suggest that methylphenidate may be beneficial in this small select type of patients. No adverse drug information was formally collected (the authors reported several patients withdrew from the study due to blurred vision, confusion, and dizziness but did not address whether these might be drug- or disease-related); thus, nurses would need to monitor patients closely who receive these drugs.