title: Single Institute Experience With Methylphenidate and American Ginseng in Cancer-Related Fatigue.
abstract: BACKGROUND
  Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown.
  
  
  OBJECTIVE
  The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy.
  
  
  METHODS
  We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents.
  
  
  RESULTS
  We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue (cutoff value: ≥3; reduction in fatigue score from baseline: 80% ≥2, 60% ≥3, and 46.7% ≥4).
  
  
  CONCLUSIONS
  In our retrospective medical record review, the combination treatment of methylphenidate and AG had no discernible associated toxicities and showed potential clinical benefit in CRF.
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Young D
authors.initials: YD
authors.lastname: Chang
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Smith
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Portman
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kim
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Ritika
authors.initials: R
authors.lastname: Oberoi-Jassal
authors.affiliation: 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
authors.forename: Sahana
authors.initials: S
authors.lastname: Rajasekhara
authors.affiliation: 2 Palliative Medicine, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Mellar
authors.initials: M
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000529:Complementary Therapies; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D005894:Panax; D012189:Retrospective Studies
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate
keywords: cancer; combination; fatigue; ginseng; herbal; methylphenidate; psychostimulant