A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue.
BACKGROUND
Cancer-related fatigue is an important clinical problem. It is common, distressing, and often difficult to treat. There is a role for drug treatment of cancer-related fatigue, but no consensus has been reached on which drugs are useful. This systematic review and meta-analysis aims to review the available evidence and make recommendations for practice and research.


METHODS
We searched the Cochrane register of controlled trials (through the second quarter 2007), Medline (January 1, 1966, through August 1, 2007), and EMBASE (January 1, 1980, through August 1, 2007) by use of a predetermined list of search terms. Cochrane Collaboration meta-analysis review methodology was used for this study. The change in fatigue score on the instrument used in each study and other outcomes of interest (adverse events and withdrawal rates) were compared between treatment and control arms by use of the standardized mean difference (SMD) with 95% confidence intervals (CIs). All statistical tests were two-sided.


RESULTS
We identified 27 eligible trials of drug treatments for cancer-related fatigue (with a total of 6746 participants). The overall effect size for all drug classes was small. A meta-analysis of two studies (n = 264 patients) indicated that methylphenidate (a psychostimulant) was superior to placebo (standardized mean difference [SMD] in change in fatigue score = -0.30, 95% confidence interval [CI] = -0.54 to -0.05; P = .02) for treating cancer-related fatigue. A meta-analysis of 10 studies (n = 2226 patients) evaluating erythropoietin in anemic cancer patients who were undergoing chemotherapy indicated that erythropoietin was superior to placebo (SMD = -0.30, 95% CI = -0.46 to -0.29; P = .008). Among anemic patients (four studies with n = 964 patients), improvement in fatigue was associated with darbepoetin treatment compared with placebo treatment (SMD = -0.13, 95% CI = -0.27 to 0.00; P = .05). Progestational steroids and paroxetine were no better than placebo in the treatment of cancer-related fatigue.


CONCLUSIONS
There is some evidence that treatment of cancer-related fatigue with methylphenidate appears to be effective. More robust evidence indicates that treatment with hematopoietic agents appears to relieve cancer-related fatigue caused by chemotherapy-induced anemia. Further confirmatory trials are required for both observations.
Minton
Ollie
O
Division of Mental Health, St George's University of London, Cranmer Terrace, London, UK. ominton@sgul.ac.uk
Richardson
Alison
A
Sharpe
Michael
M
Hotopf
Matthew
M
Stone
Patrick
P
D000740:Anemia / Q000139:chemically induced / Q000150:complications*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D000068256:Darbepoetin alfa; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D004921:Erythropoietin / Q000031:analogs & derivatives / Q000627:therapeutic use; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology*; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use*; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D016017:Odds Ratio; D017374:Paroxetine / Q000627:therapeutic use; D011372:Progestins / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D000970:Antineoplastic Agents; D000697:Central Nervous System Stimulants; D018765:Dopamine Uptake Inhibitors; D006397:Hematinics; D011372:Progestins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D008774:Methylphenidate; D017374:Paroxetine