title: L-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis.
abstract: Nutritional factors are among the postulated causes of fatigue, a highly prevalent symptom in the cancer population, with serious impact on patients' quality of life. Deficiency of the micronutrient carnitine may play a role by reducing energy production through fatty acid oxidation. We present preliminary data of an open-label, dose-finding study to determine safety and maximally tolerated dose (MTD) of 1 week of L-carnitine supplementation in cancer patients with fatigue and carnitine deficiency. Patients who met inclusion/exclusion criteria underwent carnitine level determination. Eighty-three percent of these patients (15/18) had carnitine deficiency. Preliminary data analysis of 13 patients showed that total carnitine increased from 30.0 +/- 6.9 to 41.0 +/- 12.1 (mean +/- SD) after 1 week of supplementation (P = 0.01), and free carnitine increased from 24.3 +/- 6.1 to 33.8 +/- 9.8 (P = 0.004). Outcome measures were fatigue (BFI score), depression (CES-D), sleep disruption (ESS), and performance status (Karnofsky). Median (min, max) BFI score at baseline was 73 (46, 82) versus 50 (3, 82) after 1-week supplementation (P = 0.009). CES-D score at baseline was 29 (16, 42) and 22 (8, 32) after 1 week (P = 0.028). ESS at baseline was 46.5 (0, 69) and 30.4 (0, 72) after 1 week (P = 0.015). Karnofsky score did not change significantly (P = 0.38). We are currently conducting a randomized, double-blind, placebo-controlled study to rigorously assess the role of L-carnitine for the treatment of fatigue and depression in cancer patients.
authors.affiliation: Research Division, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA. rcrucian@bethisraelny.org
authors.forename: R A
authors.initials: RA
authors.lastname: Cruciani
authors.forename: E
authors.initials: E
authors.lastname: Dvorkin
authors.forename: P
authors.initials: P
authors.lastname: Homel
authors.forename: B
authors.initials: B
authors.lastname: Culliney
authors.forename: S
authors.initials: S
authors.lastname: Malamud
authors.forename: L
authors.initials: L
authors.lastname: Shaiova
authors.forename: S
authors.initials: S
authors.lastname: Fleishman
authors.forename: J
authors.initials: J
authors.lastname: Lapin
authors.forename: E
authors.initials: E
authors.lastname: Klein
authors.forename: P
authors.initials: P
authors.lastname: Lesage
authors.forename: R
authors.initials: R
authors.lastname: Portenoy
authors.forename: N
authors.initials: N
authors.lastname: Esteban-Cruciani
mesh_terms: D002331:Carnitine / Q000494:pharmacology*; D003863:Depression / Q000188:drug therapy*; D019587:Dietary Supplements; D005221:Fatigue / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic
chemical_list: D002331:Carnitine