To compare the effectiveness of three different products in reducing incidence of radiodermatitis

Women were randomly assigned to placebo (sterile water mist), Aquaphor, Biafine or RadiaCare gel. Patients were instructed to apply the product two times daily with the start of radiotherapy and until treatment was complete. Patients were not to use any other skin care product on the affected area. The radiation nurse assessed patients weekly and reminded them to complete home journals. The investigators conducted independent skin assessments on a random sample of 10% of patients to establish reliability of observations.

• The study sample was comprised of 208 female patients.
• Mean age ranged from 54–56 years.
• All patients had stage 1 or 2 breast cancer.
• Median dose was 200 cGy daily with a total dose of 6200 cGy most often. 
• The average number of treatments was 31.

The study took place in an outpatient setting at Duke University.

Patients were undergoing active antitumor treatment.

The study used a double-blind placebo-controlled randomized four-group trial design.

• Radiation Therapy Oncology Group skin toxicity scoring was used.
• Patients kept a journal of application, satisfaction, and ease of use.

Ninety-five percent of patients had a skin reaction, with most occurring by week 4. None of the products tested showed a significant difference to reduce the incidence of grade 2–4 skin toxicity compared to placebo.  Increases in the proportion with a skin reaction were greatest among those using Biafine. Increases in skin reaction were similar to each other in the other study groups. Patient adherence to use was greater than 80% during the study. Biafine was associated with the greatest increase in toxicity across groups.

None of the products tested here were better than placebo in reducing incidence of grade 2–4 radiodermatitis.

Findings suggest that none of these particular products are effective, although a systematic review and meta-analysis in this area suggest that using anything is more effective than using nothing. Further well-designed research in prevention and management of radiodermatitis is needed.

To compare the effectiveness of three products in reducing the incidence of radiodermatitis.

Women were randomly assigned to placebo (sterile water mist), Aquaphor, Biafine, or radiacare gel. Patients were instructed to apply the product two times daily with the start of radiation therapy (RT) and until treatment was complete.  Patients were not to use any other skin care product on the affected area. The radiation nurse assessed patients weekly and reminded them to complete their home journals. The investigators conducted independent skin assessments on a random sample of 10% of patients to establish reliability of the observations.

• The sample was comprised of 208 women. 
• Mean age across all groups ranged from 54 to 56 years.
• Patients had stage 1 and 2 breast cancer.
• Median dose was 200 cGy daily, and total dose was 6200 cGy most often.
• The average number of treatments was 31.

• Single site 
• Outpatient  
• Duke

Patients were undergoing the active antitumor treatment phase of care.

The study was a double-blind, placebo-controlled, randomized, four-group trial.

• Radiation Therapy Oncology Group (RTOG) skin toxicity scoring
• Patient journal of application, satisfaction, and ease of use

Of the patients, 95% had a skin reaction, with most occurring by week 4. No product tested showed a significant difference in reducing the incidence of grade 2 to 4 skin toxicity compared to placebo. Increases in the proportion with a skin reaction were greatest among those using Biafine. Increases in skin reactions were similar to each other in the other study groups. Patient adherence to use was greater than 80% during the study.

 No product tested was better than placebo in reducing the incidence of grade 2 to 4 radiodermatitis.

Biafine, Aquaphor, and radiacare gel were no more effective than placebo in reducing the incidence of clinically relevant skin toxicity with RT in patients with breast cancer. Biafine was associated with the greatest increase in toxicity across groups. Findings suggested that none of these products are effective, although a systematic review and meta-analysis in this area suggests that using anything is more effective than using nothing. Further well-designed research in prevention and management of radiodermatitis is needed.

• To perform a meta-analysis to obtain a current, comprehensive, and robust estimate of the effect of psychosocial interventions on cancer-related pain
• To determine  whether the effects of psychosocial interventions on pain in patients with cancer differ by intervention type (skills- versus education-based approach)
• To explore, in the study context, the relationship between intervention design and patient sociodemographics

• Databases searched were MEDLINE, PsycINFO, CINAHL, EMBASE, and the Cochrane Library.
• Search terms indicating pain (e.g., pain, nociceptors) and presence of cancer (e.g., neoplasm, cancer, leukemia) were combined with terms relating to psychosocial interventions (e.g., psychotherapy, hypno$, desensitis$, meditate$) and publication types (e.g., randomized controlled trial, controlled clinical trial).
• Studies were included if they
  • Were published in English on a date that fell in a period after the earliest date available in each database and before 2011.
  • Included adult subjects (those 18 years old or older) with a diagnosis of cancer or who were undergoing procedures for diagnosis of cancer.
  • Employed random assignment.
  • Assessed pain.
  • Included a usual-care or no-treatment control condition.
  • Employed a psychosocial intervention—that is, any approach involving cognitive behavioral techniques, stress management, relaxation training, education, hypnosis, or other experiential techniques. (Interventions could be provided in any of multiple formats, including individual, group, couples, telephone, or Internet-based modality.)
• Studies were excluded if they used alternative therapies as the primary treatment, as is the case with massage and Reiki therapy.
   

The search retrieved 1,681 studies published 1996–2010. Three pairs of raters independently reviewed 1,681 abstracts, using an online coding program designed for this project. Studies meeting the inclusion criteria were evaluated for quality according to a modified seven-item coding scheme based on the Physiotherapy Evidence Database. The project leader reviewed findings from rater pairs, resolved discrepancies, and produced a final list of studies for full-text examination. The list of studies was divided among the three pairs of raters.
 

• The number of studies that met inclusion criteria was 42; 37 provided sufficient data for meta-analysis.
• The total sample was composed of 4,199 patients.
• Authors did not report the sample range.
• Of all patients, 66% were women. The sample was primarily white (72%). Most of the studies (65%) included cancer at various stages at baseline. At baseline, 54% of the sample was receiving chemotherapy. Of all patients, 71% were receiving outpatient care.

The weighted average effect size in 38 comparisons for pain severity (k = 38) was 0.34 (95% CI 0.23–0.46; p < 0.001). The weighted average effect size in four comparisons for pain interference was 0.40 (95% CI 0.21–0.60; p < 0.001). Among studies that measured pain severity, skills-based interventions yielded a higher but statistically nonsignificant effect size than did educational approaches (k = 18, g = 0.45 versus k = 19, g = –0.29, respectively; p = 0.22).

Psychosocial interventions decrease cancer-related pain severity and the extent to which pain interferes with activities. Both skills instruction and education approaches can improve the management of cancer pain.

To evaluate the tolerability, efficacy, and pharmacokinetics of aprepitant with a 5-HT₃ receptor antagonist and corticosteroid in adolescents with cancer

Patients were randomized to receive either a regimen of aprepitant plus dexamethasone and ondansetron or the control arm of ondansetron and dexamethasone. On the day of chemotherapy, aprepitant or placebo was administered 1 hour before and dexamethasone and ondansetron were given 30 minutes before chemotherapy. Rescue medication was permitted. Patient follow-up was done between days 6 and 8 and between days 19 and 29. Patients recorded episodes of vomiting in diaries for five days following chemotherapy. For the experimental arm, aprepitant was given at 125 mg day 1, 80 mg days 2 and 3, 4 mg day 4; 8 mg dexamethasone day 1, 4 mg days 2 and 3; and ondansetron at 0.15 mg/kg, three times per day on days 1 and 2. In the control arm, patients received 16 mg dexamethasone on day 1, 8 mg on days 2–4, and ondansetron at 0.15 mg/kg, three times per day on days 1 and 2.

• The study consisted of 40 participants.
• The mean age was 15 years old, with a range of 11–19 years.
• The sample was 29% female and 61% male.
• The most common diagnosis was bone sarcoma.
• Patients were scheduled to receive emetogenic chemotherapy or had previously intolerable therapy because of chemotherapy-induced nausea and vomiting (CINV).

The study was conducted at a single outpatient setting at Children’s Hospital, University of Colorado.

The patients were pediatric, in active treatment.

This was a randomized, double-blind, parallel group study.

• Complete response (CR) was defined as no episodes of vomiting and no use of rescue medication.
• Measurement instruments were patient diaries and Common Terminology for Adverse Events (CTAE).

• No serious, drug-related, adverse events were reported. Among those treated with aprepitant, the most common reported side effect was hiccups (15.6%).
• Comparison of response rates were, overall, 28.6% with aprepitant and 5.6% with controls.
• In the acute phase (0–24 hours), 60.7% with aprepitant had CR, compared to 38.9% in controls.
• In the delayed phase (24–120 hours), 35.7% with aprepitant had CR, compared to 5.6% in the control group.
• Analysis showed that the treatment difference in favor of the aprepitant triple therapy began at about 15 hours after chemotherapy administration.
• Pharmacokinetic analysis was compared to that previously done in adults and showed more variability in adolescents.

More patients in the aprepitant group achieved CR for CINV control in the acute and delayed phases, as well as in the overall study period. The addition of aprepitant to the antiemetic regimen appeared to be well tolerated in adolescents, with an overall adverse event profile similar to that seen in adults.

• The study had a small sample of less than 100 participants.
• The study was likely underpowered to demonstrate statistically significant results.
• The chemotherapeutic regimens were not described, so the emetogenicity was not clear and cannot be compared to other groups.
• The study was for a short period of only five days.
• The measure of CR was apparently based on patient diary results. Description of actual vomiting episodes was not provided, and compliance with diary recording was not described, although this is a method that is well known to be potentially problematic.
• Efficacy in terms of nausea was not discussed, as CR was defined only in terms of actual vomiting and use of rescue medication. No additional objective measure of the severity of nausea or vomiting was included.
• Statistical significance was not reported; only confidence intervals for findings were given.

Findings suggest that aprepitant in addition to standard antiemetic treatment is tolerable and may be helpful in patients between the ages of 11 and 19. Further study of the efficacy of antiemetic regimens in the pediatric and adolescent populations is warranted.

To evaluate the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer

Fifty patients were randomized to receive 200 mg of thalidomide by mouth daily or placebo for 24 weeks. At four weeks, 33 patients were evaluated; at eight weeks, 20 patients were evaluated.

Patients were included in the study if they

• Had inoperable pancreatic cancer
• Experienced 10% weight loss over the preceding six months
• Had a life expectancy of at least six weeks.

Patients were excluded if they

• Had received any form of antineoplastic treatment in the preceding six weeks
• Weighed less than 40 kg
• Concurrently used steroids, anabolic drugs, hormonal agents, or appetite stimulants
• Were younger than 18 years of age
• Had peripheral neuropathy
• Had severe constipation.

The study was a randomized, placebo-controlled trial.

• Primary outcome: Change in weight at four weeks
• Secondary outcomes:
  • Change in bone and free muscle mass
  • Grip strength
  • Quality of life (physical performance and global health status)
  • Survival

At four weeks, 33 patients were evaluable. The thalidomide arm gained 0.37 kg in weight and 1 cm³ of arm circumference muscle mass. The placebo arm lost 2.21 kg in weight and 4.46 cm³ of arm circumference muscle mass.

At eight weeks, 20 patients were evaluable. The thalidomide arm lost 0.06 kg in weight and 0.5 cm³ of arm circumference muscle mass. The placebo arm lost 3.62 kg in weight and 8.4 cm³ of arm circumference muscle mass.

Thalidomide was well tolerated and effective at attenuating weight loss and loss of lean body mass. Findings were unable to demonstrate that attenuation in weight loss led to improvement in quality of life.

• The study had a high attrition rate: 70% were evaluable at four weeks, and 43% were evaluable at eight weeks.
• Baseline weight in the control group was 4 kg lighter.
• Change in appetite was not measured as a primary outcome.

To demonstrate the efficacy, safety, and acceptability of intranasal sufentanil as a treatment for cancer-related breakthrough pain (BTP)

Dose titration included three steps. In step 1, a clinician administered 9 mcg sufentanil. Administration was repeated at 10 and 20 minutes, as  required. If sufentanil was ineffective at 30 minutes, the clinician administered, the patient's usual BTP opioid. Step 2 comprised actions relating to the next episode of BTP. During this episode, the clinician administered 18 mcg sufentanil, using the same repetition procedure as in step 1. In step 3, during the next episode of BTP, the clinician administered 36 mcg sufentanil, using the same repetition procedure as in step 1. In all steps, pain was assessed at 0, 5, 10, 15, 30, 60, and 120 minutes. In the ongoing phase of the study, in each BTP episode, each patient received the titrated dose that had proven effective.

• The sample was composed of 30 patients. The study comprised 64 BTP episodes.
• Authors did not report information about patients' ages.
• Authors did not report information about the gender of patients.
• The sample comprised patients who had cancer, were not opioid naive, showed clinical evidence of opioid responsiveness, and were taking stable doses of long-acting opioids. The sample included 11 cases of neuropathic pain, 7 of visceral pain, 6 of somaic pain, 5 of mixed pain, and one of pain of an unknown type. No patient died during the study.

• Multisite
• Inpatient
• Three palliative care units in Australia

Prospective, descriptive study

• Verbal rating, on a 0–10 scale, of percentage of pain intensity difference (%PID)
• Respiratory rate
• Oxygen saturation
• Presence or absence of nausea, vomiting, confusion, nasal pain, or nasal bleeding
• Drowsiness scale (0 = none, 4 = unarousable)

• Median verbal rating of PID at baseline was 5.5, mean rating was 5.9 (SD = 1.8); median verbal rating of PID at 15 minutes was 3, mean rating was 3.3 (SD = 2.3) (p < 0.0001); median verbal rating of PID at 30 minutes was 2, mean rating was 2.5 (SD = 2.4) (p < 0.0001).
• The %PID was greater than 33% at 30 minutes, by which time 40 of 64 patients (63%) had responded to treatment.
• Dose range was 9–108 mcg. Median dose was 18 mcg.
• Of 30 participants, 23 rated intranasal sufentanil as better than usual medications.
• Four of 64 patients (6%), reverted to usual BTP medication after 30 minutes.
• Authors found no correlation between baseline opioid dose and the dose that was effective in treating BTP.
• In three episodes the drowsiness score was higher than 2. In two patients, the adverse effect was nausea. In one patient, the adverse effect was headache.

The study showed that intranasal sufentanil has rapid onset and is an effective and safe means of controlling cancer-related BTP.

• The study had a small sample, with fewer than 100 patients.
• Authors did not provide a definition of effective pain relief.
• Authors did not provide demographic information.

Sufentanil may be an option for the treatment of BTP; presently, however, its use remains investigational.

Southwest Oncology Group Study 9626 evaluated  megestrol for management of menopausal symptoms in women with breast cancer. It compared two doses of megestrol acetate  versus placebo over six months. Participants were randomized to placebo, megestrol 20 mg, or megestrol 40 mg daily for three months. If success was achieved, treatment continued for three additional months. If not, the patient was unblinded and given megestrol 20 mg daily.

Participants: 288 patients with T 1-3, N0-1 breast cancer following surgery, chemotherapy, and at least four months of tamoxifen, if prescribed, were enrolled. 225 completed the trial.

This was a phase III, randomized, placebo-controlled, double-blind trial.

At the initial evaluation, patients completed a seven-day patient daily log of hot flashes with re-evaluation at three and six months. The primary endpoint was differences in the probability of hot flash reduction in three comparison groups.  Instruments included:

• The patient report of menopausal symptoms
• The symptom log
• National Cancer Institute Common Toxicity Criteria, version 2.
• Performance status assessed using ECOG scale

At three months, improvement was 14% with placebo, 65% withmegestrol acetate 20 mg, and 48% with megestrol acetate 40 mg. Both doses were superior to placebo (p < .0001). Duration of effectiveness continued at six months. Megestrol 40 mg was not superior to megestrol 20 mg.

The recommended daily dose is 20 mg.

The study was not designed to evaluate long-term toxicities or relapse of symptoms with long-term use. Concern remains regarding the use of progestins in women with a history of breast cancer.

To determine if there is sufficient evidence that pre-emptive antifungal treatment is as effective as antifungal prophylaxis with posaconazole. The patient populations addressed included patients with acute myelogenous leukemia or myelodysplastic syndrome with prolonged chemotherapy-induced neutropenia and allogeneic hematopoietic stem cell transplantation (HSCT) recipients with significant graft-versus-host disease.

Prophylactic antifungal therapy is defined as the initiation of an antifungal agent to high-risk patients to prevent a fungal infection. Pre-emptive antifungal therapy is defined as the initiation of antifungal therapy in high-risk patients based on laboratory markers, radiologic monitoring, or both to identify early ​invasive fungal infections (IFIs) before clinically overt disease develops. The authors based their evaluation on the principle that prophylaxis of fungal infections is important due to the significant morbidity and mortality associated with fungal infections, the incidence in high-risk patients, the safety of available antifungal agents, and the lack of sensitive methods of early detection. A pre-emptive approach is limited by the sensitivity and specificity of available detection methods. The authors reviewed the current literature on posaconazole prophylaxis and pre-emptive antifungal therapy.

No databases used for a search were listed, nor were any inclusion or exclusion criteria mentioned. However, keywords searched were invasive fungal infection, prophylaxis, pre-emptive therapy, and aspergillosis.

One prospective, randomized trial compared posaconazole with fluconazole or itraconazole as a primary antifungal prophylaxis in patients with acute myelogenous leukemia or myelodysplastic syndrome with prolonged chemotherapy-induced neutropenia. Proven or probable IFIs occurred in seven (2%) patients in the posaconazole group and 25 (8%) patients in the fluconazole or itraconazole group (p < 0.001). Significantly fewer patients in the posaconazole group had invasive aspergillosis. Survival was improved in posaconazole recipients (p = 0.04). Serious adverse events possibly related to treatment occurred in 6% of patients in the posaconazole group and in 2% in the fluconazole or itraconazole group (p = 0.01).

One prospective, randomized trial compared primary antifungal prophylaxis with posaconazole versus fluconazole in allogeneic HSCT recipients with significant graft-versus-host disease on immunosuppression. Posaconazole was at least as effective as fluconazole in preventing IFIs during the prespecified period of observation (incidence, 5.3% versus 9%, respectively; p = 0.07) but was superior in preventing invasive aspergillosis and deaths caused by IFIs. If the analysis was restricted to the period in which patients received the study drug, posaconazole was considered superior to fluconazole in preventing IFIs (incidence, 2.4% versus 7.6%; p = 0.004), particularly invasive aspergillosis (incidence, 1% versus 5.9%; p = 0.001). Treatment-related adverse events were similar between the groups. One peer-reviewed publication reported pre-emptive antifungal therapy. The study was a feasibility study in which a total of 136 treatment episodes for patients with neutropenia at high risk for IFI were screened with daily serum galactomannan testing. There was a diagnostic algorithm that included chest computed tomography (CT) scans and bronchoalveolar lavage. Patients who met prespecified criteria for probable or proven invasive fungal infection received pre-emptive therapy with liposomal amphotericin B; neutropenic fever alone did not trigger modification in the antifungal regimen. Although this approach was successful in identifying early invasive aspergillosis and avoiding amphotericin B use in most patients with persistent neutropenic fever of unknown origin, invasive aspergillosis developed in 17 patients and zygomycosis in one patient among 136 chemotherapy treatment episodes. All cases of invasive aspergillosis were identified through positive antigenemia results. Seven (41%) deaths occurred in patients with positive serum galactomannan results; of these, six had autopsy-proven invasive aspergillosis. However, only two patients were considered to have died directly because of invasive aspergillosis.

The authors believe that insufficient evidence exists to recommend a pre-emptive antifungal therapy approach in place of posaconazole prophylaxis in patients with acute myelogenous leukemia or myelodysplastic syndrome with prolonged chemotherapy-induced neutropenia and allogeneic hematopoietic cell transplantation (HCT) recipients with significant graft-versus-host disease.

No conflict of interest was stated.

Posaconazole is recommended as a primary antifungal prophylaxis in patients with acute myelogenous leukemia or myelodysplastic syndrome with prolonged chemotherapy-induced neutropenia and in allogeneic HCT recipients with significant graft-versus-host disease. Pre-emptive treatment is not recommended in these patient populations.

To assess the effectiveness of and adverse events associated with opioid rotation for the management of cancer-related pain

All consecutive patients who attended the clinics of participating hospitals were eligible. A single opioid conversion table was used by all participants. If a rotation was used because of pain and toxicity, the baseline dosage was reduced by 25%–50% prior to the change. If no toxicity was present, an equivalent dose was used. Pain was assessed days prior to the implementation of the rotation and one week postimplementation. During the week, changes in opioid dosage were allowed and recorded. Patients were followed for 90 days.

• N = 67  
• MEDIAN AGE = 61 years (range 27–91 years)
• MALES: 73.1%, FEMALES: 26.9%
• KEY DISEASE CHARACTERISTICS: Various tumor sites; lung cancer was most prevalent; most had advanced disease
• OTHER KEY SAMPLE CHARACTERISTICS: Pain was nociceptive in 53.6% and mixed or neuropathic in 46.3%

• SITE: Multi-site  
• SETTING TYPE: Outpatient  
• LOCATION: Spain

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Palliative care 

Observational

• Numeric Rating Scale (NRS) for average and breakthrough pain
• Number of breakthrough episodes per day
• Common Terminology Criteria for Adverse Events (CTCAE)

About 89.5% of patients had one opioid rotation. The most common drugs used for the rotation were morphine, fentanyl, and transdermal buprenorphine. The most common switch was from fentanyl to morphine. The rotation was effective in 75.4% of patients for reducing average pain and in 57.8% for breakthrough pain. Average pain decreased at day 7 (p < 0.001) by four points, breakthrough intensity decreased by four points (p < 0.001), and the number of breakthrough episodes decreased on average from three to one (p < 0.001). Among patients in whom the rotation was effective, there were no significant differences between pre- and postequivalent doses of opioids. In 10 switches (out of a total of 75), there were no toxicities postrotation at one week. Rotations to methadone appeared to be associated with more postrotation adverse events.

The results of this study suggest that opioid rotation can be effective for pain management and the reduction of opioid-associated toxicities in most patients. Rotations to methadone appeared to be associated with more toxicities than rotations to other medications.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Questionable protocol fidelity
• Other limitations/explanation: Throughout the study period, the total opioid doses were not maintained although there was no overall significant difference in the morphine equivalents found. The study reported results at only one week. There was no information on the length of time patients received opioids prior to the study or the severity of toxicities prior to the rotation. There was no information regarding any potential adjuvant medication use.

In patients with severe cancer-related pain, opioid rotations may be beneficial for improving pain management and addressing opioid-related toxicities. However, the duration of this effect is not clear. These results suggest that switching to methadone might not be the best choice for reducing toxicities.

To assess the safety and efficacy of methylphenidate for cancer-related fatigue. Secondary outcomes included depression, cognition, and adverse effects.

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: PubMed. EMBASE, PsycINFO, Cochrane Collaboration

KEYWORDS: Methylphenidate, dimethylphenidate, Ritalin, cancer, fatigue, asthenia, tiredness, and randomized controlled trial

INCLUSION CRITERIA:  Randomized controlled trials, adults older than 18 years, the trial examined efficacy of methylphenidate on fatigue, and results were sufficient to calculate effect sizes

EXCLUSION CRITERIA: None specified

TOTAL REFERENCES RETRIEVED: N = 374

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The Jadad scale was used for quality assessment.

• N (studies) = 5
• SAMPLE RANGE ACROSS STUDIES: 10–62
• TOTAL PATIENTS INCLUDED IN REVIEW: 198
• KEY SAMPLE CHARACTERISTICS: Three studies included mixed tumor types, one was in prostate, and one was in patients with primary brain tumor.

PHASE OF CARE: Multiple phases of care

Meta-analysis was done with studies grouped according to the measure of fatigue that was used. In studies using the FACT-F (three studies), results showed a favorable effect of methylphenidate with a mean difference of -3.13 and a signficant overall effect (p -0.01). In studies using the BFI, results showed a favorable effect with mean difference of -0.69, but the Z test of overall effect was not significant. Methylphenidate had no effect on depression (two studies) or cognitive impairment (two studies). Studies varied widely in terms of the duration of treatment. Treatment for greater than four weeks was superior compared to placebo. However, treatment for less than four weeks did not show a significant effect compared to placebo. Rates of adverse effects between those getting methylphenidate and those getting a placebo were not significantly different. Those receiving methylphenidate had significantly more vertigo, anxiety, and nausea.

Results suggest that treatment with methylphenidate for at least four weeks is effective in reducing cancer-related fatigue and is not associated with a high rate of adverse effects. Treatment with methylphenidate did not improve depression or cognitive impairment. Use of different methods of measurement of fatigue showed different results.

Few studies were included, and some of these had very small sample sizes. Included studies did not provide sufficient information on relevant concomitant conditions of patients, such as sleep disorders and anxiety. Dosages and dosage increase approaches with methylphenidate varied.

Findings suggest that treatment with methylphenidate for at least four weeks can be helpful in managing cancer-related fatigue. However, the most appropriate dosages are not clear. Patients can experience side effects, and if methylphenidate is used, nurses need to monitor patients for side effects. Further large studies are needed to strengthen evidence related to effects and side effects of methylphenidate.