title: Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review.
abstract: In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases.
  
  
  
  We considered randomized controlled trials concerning adult palliative care with a focus on pharmacological treatment of fatigue compared with placebo, application of two drugs, usual care or a non-pharmacological intervention. The primary outcome had to be non-specific fatigue (or related terms such as asthenia). We searched the CENTRAL, MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. Two review authors independently assessed trial quality and extracted the data.
  
  
  
  We screened 1645 publications of which 45 met the inclusion criteria. In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials. Meta-analysis of data was possible for modafinil, pemoline, and methylphenidate.
  
  
  
  Due to the limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Some drugs, which may be beneficial for the treatment of fatigue associated with palliative care such as amantadine, methylphenidate, and modafinil, should be further researched.
authors.affiliation: Department of Palliative Medicine University Hospital Bonn Bonn Germany; Department of General Practice and Family Medicine University Hospital Bonn Bonn Germany; Center for Rare Diseases Bonn (ZSEB) University Hospital of Bonn Bonn Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mücke
authors.affiliation: Department of Palliative Medicine University Hospital Bonn Bonn Germany; Department of Anesthesiology and Intensive Therapy University of Diponegoro/Kariadi Hospital Jawa Tengah Indonesia.
authors.lastname: Mochamat
authors.affiliation: Department of Palliative Medicine University Hospital Bonn Bonn Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Cuhls
authors.affiliation: Medical Faculty RWTH Aachen University Hospital of Aachen Aachen Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Peuckmann-Post
authors.affiliation: Division of Mental Health St George's University of London London UK.
authors.forename: Ollie
authors.initials: O
authors.lastname: Minton
authors.affiliation: Marie Curie Palliative Care Research Department UCL Division of Psychiatry London UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stone
authors.affiliation: Department of Palliative Medicine University Hospital Bonn Bonn Germany; Centre for Palliative Care Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg Bonn Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
keywords: Advanced disease; Fatigue; Palliative care; Pharmacological treatments; Systematic review