Abstract
Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct). For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, cinahl, and Psychinfo for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of hsct. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), l-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (smd): -0.52; 95% confidence interval (ci): -0.89 to -0.14] and with methylphenidate (smd: -0.36; 95% ci: -0.56 to -0.15); modafinil (or armodafinil) and corticosteroids were not effective. Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of hsct. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
Highlights
Cancer-related fatigue is increasingly being recognized as one of the most important symptoms in patients with cancer 1,2
Fatigue was significantly reduced with erythropoietin [standardized mean difference: –0.52; 95% confidence interval: –0.89 to –0.14] and with methylphenidate; modafinil and corticosteroids were not effective
Cancer-related fatigue can affect up to 80%–90% of cancer patients, and it can occur before diagnosis, during cancer treatment, and after completion of cancer therapies 1,4–9
Summary
Cancer-related fatigue is increasingly being recognized as one of the most important symptoms in patients with cancer 1,2. It has been described as an unexpected tiredness that is more intense and severe than the fatigue experienced in healthy people 3. Recipients of hematopoietic stem-cell transplantation (hsct) experience fatigue, likely related to similar underlying mechanisms 12,13. Interventions including physical activity and psychological and pharmacologic approaches have been investigated for the management of fatigue in cancer patients, and several systematic reviews have been published 14–22. Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (hsct)
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