Methylphenidate for Cancer-Related Fatigue in Children Receiving Pediatric Palliative Care (S752)

Abstract

•Describe patterns of methylphenidate administration in children with cancer related fatigue.•Delineate patterns of side effects among children who received methylphenidate for cancer related fatigue. Methylphenidate (MPH) is a common symptomatic treatment of cancer-related fatigue (CRF). However, little evidence guiding its use for CRF in children exists. To describe characteristics, efficacy and side effects of MPH in children with CRF. A retrospective chart review was conducted for children who received cancer related care at a large academic center (January, 2000-June, 2015), were followed by the pediatric palliative care team and prescribed MPH for CRF. Child demographic and clinical characteristics were abstracted as were data related to concomitant opioid use. Clinician descriptions of fatigue prompting MPH treatment were collected, along with data regarding MPH efficacy and side effects. Results were summarized with descriptive statistics including frequencies and measures of central tendency. A total of 63 patients, 49% female, median (IQR) age 16 (13-19) were identified. About half (54%) had solid tumors; fewer had a brain tumor (22%), hematologic malignancy (19%) or hematopoietic stem cell transplant (5%). Over half (59%) received chemotherapy and 14% received radiation 2 weeks prior to initiating MPH. Many (68%) were on opioids at the time of MPH initiation. Patients started MPH a median (IQR) of 23 (8.4-36.5) months after cancer diagnosis and a median (IQR) of 3 (1-7) months before death. The mean (SD) starting dose of MPH was 0.22 mg/kg (0.17). The majority h90%) had a documented reduction in CRF. Among those who reported improvement, over half (51%) did not require any subsequent dose adjustment. Fourteen children reported a total of 18 side effects. The most common side effects were mood disturbance (6 reports); headache, sleep disturbance, anorexia and increased focus (2 reports each). Five children discontinued MPH due to intolerable side effects. Methylphenidate was effective and well tolerated by children with CRF.