Schwartz, A. L., Thompson, J. A., & Masood, N. (2002). Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncology Nursing Forum, 29, E85–E90.

Patients took methylphenidate 20 mg sustained release every morning and followed an aerobic exercise program for 15 to 30 minutes four days a week. Aerobic exercise is hypothesized to decrease fatigue by improving physical conditioning and mental concentration.

• Eight patients were included (compared with four patients who were unable to tolerate methylphenidate and were receiving exercise alone and 16 historic controls). 
• Most patients were Caucasian, college educated, worked full-time, and had stage III metastatic melanoma.
• Gender was not reported.
• All patients were newly diagnosed and being treated with interferon-alpha.
• Patients had undergone previous surgery but no other therapies.
• Only two patients exercised regularly prior to study entry.
• All patients received interferon-alpha at a dose of 5 million IU/m².
• Patients were excluded if they had uncontrolled hypertension; anxiety disorders; active central nervous system metastasis; or a history of glaucoma, motor tics, seizure disorders, or Tourette’s syndrome.

• Outpatient
• Large university cancer center

This was an open-label pilot study with comparison to historic controls.

• Schwartz Cancer Fatigue Scale (SCFS), completed at monthly intervals
• Functional status for 12-minute walk time
• Medical Outcomes Study (MOS) Short Form 36 (SF-36)
• Trail Making Test (TMT) Parts A and B

All patients adhered (as determined by patient diaries) to the exercise portion of the intervention over the four months of the study. Four of 12 patients were unable to adhere to methylphenidate:  three refused to continue on methylphenidate beyond the first 48 hours of the study (reasons for discontinuation included indigestion, mild nervousness, and unwillingness to take more pills), and one had methylphenidate discontinued by the investigators due to marked anxiety. Patients receiving exercise and methylphenidate or exercise alone experienced lower fatigue levels compared to historic controls. Patients who exercised and took methylphenidate reported the lowest levels of fatigue. The exercise-only group experienced a greater decline in cognitive function when compared with patients who exercised and took methylphenidate. Patients in the in exercise and methylphenidate group lost 8.1 kg, and those in the exercise-only group lost 8.2 kg.

• The study used an open-label design.
• The study lacked randomization.
• The study had a small sample size.
• The study failed to include a depression measure.

Special training or consultation may be required to prescribe an exercise program for patients with cancer. Cost is related to drug acquisition.