title: Fatigue in chronically ill patients.
abstract: OBJECTIVE
  Fatigue is the most common symptom among palliative patients, often considered more distressing than pain, nausea or vomiting. This article reviews the current literature and puts forward up to date treatment recommendations.
  
  
  RESULTS
  Methylphenidate showed a small but significant improvement versus placebo in a recently published systematic review. Donepezil did not show a significant benefit versus placebo in a double blind, placebo-controlled study. Hypogonadism is a frequent condition that can cause fatigue in patients with advanced cancer and other chronic illnesses and androgen replacement therapy warrants further investigation. Among antidepressants, bupropion has shown encouraging results. The role of hematopoietic agents for advanced cancer patients receiving palliative care is minimal as anemia is less of a contributing factor in this setting. Cytokine receptor antagonists play an important theoretical role but further studies are needed before they could be recommended. L-Carnitine has shown encouraging results.
  
  
  CONCLUSIONS
  Methylphenidate is still considered the first choice of treatment among pharmacological therapies. Modafinil shows promise, but insufficient studies have been conducted in this setting. Bupropion may have benefits in treating depression and fatigue. Among complementary therapies, L-carnitine has the most potential. Further studies are needed before cytokine receptor antagonists and androgen replacement therapy can be recommended.
authors.affiliation: Pain Medicine and Palliative Care, Richard E. Winter Cancer Treatment Center, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA. jdharris@chmc.org
authors.forename: Juan-Diego
authors.initials: JD
authors.lastname: Harris
mesh_terms: D002908:Chronic Disease; D005081:Exercise Therapy; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D010166:Palliative Care; D010353:Patient Education as Topic