Sugawara, Y., Akechi, T., Shima, Y., Okuyana, T., Akizuki, N., Nakano, T., . . . Uchitomi, Y. (2002). Efficacy of methylphenidate for fatigue in advanced cancer patients: a preliminary study. Palliative Medicine, 16, 261–263.

Immediate-release methylphenidate was given at a dose ranging from 5 to 30 mg per day; 11 of 16 patients were given 10 mg per day. The study was based on the hypothesis that methylphenidate may improve fatigue by counteracting the adverse effects of opiates or relieving depression.

Posttreatment assessment was conducted as soon as two days after the initiation of therapy (median of seven days after initiation of methylphenidate).

• In total, 16 patients (6 females, 10 males) were included.
• Five patients had lung cancer and 11 had a mixed group of solid tumor diagnoses.
• Half of the sample was experiencing pain, and nine were taking corticosteroids.
• Four patients had been diagnosed with major depression before the initiation of the study.

• Inpatient and outpatient
• One of two large comprehensive cancer centers

Patients were undergoing the end of life phase of care.

This was a prospective, open-label, pilot study.

A visual analog scale (VAS) was used to assess fatigue before premethylphenidate and after a median of seven days.

A statistically significant difference was found between the mean fatigue score before treatment with methylphenidate and the fatigue score after treatment. Following treatment with methylphenidate, patients reported lower fatigue scores, and six patients were classified by the investigators as having responded (defined by the investigators as a 30% improvement in fatigue severity score from pre- to posttreatment) to treatment with methylphenidate. Concomitant depression and the use of opioids did not predict methylphenidate efficacy. Two patients discontinued because of insomnia, and one reported mild palpitations but opted to continue methylphenidate. Adverse reactions reported generally were limited.

• This was a small, convenience sample, with an open-label design and no comparison group that used only one fatigue measure.
• Patients received different dosages of methylphenidate.