title: Role of methylphenidate in the treatment of fatigue in advanced pancreatic cancer population.
abstract: BACKGROUND
  Fatigue is a common but devastating symptom for advanced pancreatic cancer (APC) patients. To date, no proven treatment exists. Methylphenidate (MPH) showed inconsistent results in treating other cancer related fatigue. We performed a retrospective study to assess MPH in ameliorating fatigue in APC patients.
  
  
  METHODS
  We retrospectively reviewed our clinic APC patients' records who visited from 06/2011 - 11/2014. Fatigue was assessed by Visual Analog Fatigue Scale (VAFS) and classified as grade 1 (VAFS 1-3), grade 2 (VAFS 4-6) and grade 3 (VAFS 7-10) to correspond with CTCAE V4.0. MPH was dosed at 5 mg daily in the morning and was escalated to 10 mg after 2 weeks if needed. The primary endpoint was to assess the change of fatigue grade after 4 weeks of MPH. Secondary outcomes included MPH's effect on depression, anorexia, maintenance chemotherapy intensity and adverse effects.
  
  
  RESULTS
  A total of 71 APC patients on concomitant chemotherapy were included, of whom 67% received doublet, 13% triplet, and 20% single-agent chemotherapy. Mean baseline VAFS was 7, which dropped to 4 after 4 weeks of MPH, 55% patients' fatigue score improved by 1 grade, 8% by 2 grades, 23% had fatigue resolved, 14% without benefit. 72% patients maintained chemotherapy intensity, 39% felt less depression and 52% had improved appetite. 13% stopped MPH due to side effects. Rare Grade 3 or 4 adverse events included insomnia, restlessness, palpitations and anorexia.
  
  
  CONCLUSIONS
  Our findings support low-dose MPH benefits APC patients with improved fatigue, depression and anorexia. A large randomized clinical trial is needed to confirm its usage and safety.
authors.affiliation: Montefiore New Rochelle Hospital of Albert Einstein College of Medicine, New Rochelle, NY (Zhenyang Jiang), USA.
authors.forename: Zhenyang
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Tufts University School of Medicine Tufts Cancer Center - Medical Center, Boston, MA (Harriet Butler-Bowen, Melissa Hennessey Smith, Valerie Relias, Muhammad Wasif Saif), USA.
authors.forename: Harriet
authors.initials: H
authors.lastname: Butler-Bowen
authors.affiliation: Columbia University Medical Center, New York, NY (Teresa Rodriguez, Marie C. Garcon), USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez
authors.affiliation: Columbia University Medical Center, New York, NY (Teresa Rodriguez, Marie C. Garcon), USA.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Garcon
authors.affiliation: Tufts University School of Medicine Tufts Cancer Center - Medical Center, Boston, MA (Harriet Butler-Bowen, Melissa Hennessey Smith, Valerie Relias, Muhammad Wasif Saif), USA.
authors.forename: Melissa Hennessey
authors.initials: MH
authors.lastname: Smith
authors.affiliation: Tufts University School of Medicine Tufts Cancer Center - Medical Center, Boston, MA (Harriet Butler-Bowen, Melissa Hennessey Smith, Valerie Relias, Muhammad Wasif Saif), USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Relias
authors.affiliation: Tufts University School of Medicine Tufts Cancer Center - Medical Center, Boston, MA (Harriet Butler-Bowen, Melissa Hennessey Smith, Valerie Relias, Muhammad Wasif Saif), USA.
authors.forename: Muhammad Wasif
authors.initials: MW
authors.lastname: Saif
keywords: Methylphenidate; cachexia; chemotherapy; fatigue; pancreatic cancer