Abstract
Simple SummaryCancer related fatigue is a common and distressing symptom for patients with cancer during and after primary treatment, and also in the palliative phase of the disease trajectory. This review focuses on the pharmacological treatment of cancer related fatigue in patients with advanced or metastatic cancer. There are few high-quality studies performed in this setting, but both methylphenidate and corticosteroids might be used to relieve fatigue.Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large meta-analysis of interventions on fatigue focuses mostly on patients early in the disease trajectory, with only one tenth of included studies performed in palliative cohorts. The aim of this narrative review is therefore to present a background on CRF with focus on the palliative setting. A summary of recent randomized, controlled trials on pharmacological interventions on CRF in palliative care is presented, including studies on psychostimulants, corticosteroids, testosterone and melatonin. Interestingly, in several of these studies there was a positive and similar effect on fatigue in both the intervention and the placebo arm—indicating an important placebo effect for any pharmacological treatment. In addition, studies on dietary supplements and on pharmacological complementary medicines are discussed. To conclude, the evidence is still weak for using pharmacological treatments on CRF in palliative care patients—although methylphenidate and corticosteroids might be considered.
Highlights
Different definitions have been used, but today the most widely used definition stems from the National Comprehensive Cancer Network, NCCN, “Cancer-Related Fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning” [4]
The trajectory of fatigue may change in accordance with development of the cancer disease, with physical but not mental fatigue reported to be more severe in advanced stage cancer patients compared to cancer survivors or healthy individuals [7,8,9]
This review is conducted as a narrative review of pharmacological interventions on cancer related fatigue (CRF) in palliative care to present an overview of different studies being performed up until the date November 2020
Summary
Fatigue can occur before, during and after treatment and persist for a long time [2,3]. Different definitions have been used, but today the most widely used definition stems from the National Comprehensive Cancer Network, NCCN, “Cancer-Related Fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning” [4]. The trajectory of fatigue may change in accordance with development of the cancer disease, with physical but not mental fatigue reported to be more severe in advanced stage cancer patients compared to cancer survivors or healthy individuals [7,8,9]
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