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Anemia drugs
and stimulants ease exhaustion in some
Cancer patients
Newswise — Drugs that promote red blood cell
production and stimulants typically used to
treat attention deficit disorder relieve
excessive tiredness in cancer patients,
according to a new systematic review of
studies.
Undergoing cancer treatment can affect physical,
mental and emotional well-being, and a
variety of contributing factors — such as
treatment regimens, psychological distress
and the effects of the cancer itself — can
cause cancer-related fatigue.
“Fatigue is difficult to treat as it usually has
a number of contributory causes — many of
which are not fully understood,” said lead
investigator Dr. Oliver Minton. Patients and
professionals alike may consider tiredness
as an unavoidable part of cancer treatment,
Minton said, rather than a problem to
recognize and address.
Among other therapies, drugs can improve some
symptoms of fatigue in patients, said
Minton, a clinical researcher at St.
George’s University of London.
The review analyzed 27 studies of 6,746
participants that examined the effectiveness
of certain drugs for relieving symptoms of
cancer-related fatigue.
The investigators evaluated existing randomized
controlled trials of (1) methylphenidate
(Ritalin), a stimulant medication typically
used to treat attention deficit disorders
and concentration problems; (2)
erythropoietin and darbepoietin, drugs used
to treat anemia induced by chemotherapy; (3)
paroxetine (Paxil), a medicine used to treat
depression and anxiety disorders; and (4)
progestational steroids, a type of hormone
therapy used to treat cancer.
The review appears in the latest issue of TheCochrane
Library, a publication of The Cochrane
Collaboration, an international organization
that evaluates medical research. Systematic
reviews draw evidence-based conclusions
about medical practice after considering
both the content and quality of existing
medical trials on a topic.
When it came to treating fatigue, the
effectiveness of the evaluated medications
varied widely.
“We found that drugs which improve anemia caused
by chemotherapy [also] improve fatigue,”
Minton said.
In 14 studies, taking erythropoietin or
darbepoietin proved more effective than
usual care or placebo in relieving patients’
cancer-related fatigue. However, Minton said
that the risk or occurrence of side effects,
such as aggravating hypertension and blood
clots that can lodge in the lungs, brain,
kidney or gastrointestinal tract, might
limit the use of these drugs.
Although they appear promising, patients should
also keep in mind that “the erythropoietin
findings apply only to cancer patients with
anemia,” not to all cancer patients, said
David Spiegel, M.D., psychiatrist and
professor at Stanford University School of
Medicine. He had no affiliation with the
review research.
Minton and his team also found two studies with
preliminary evidence for an improvement in
cancer-related fatigue with the use of the
psychostimulant methylphenidate.
This finding for psychostimulants is an
interesting one, because such drugs can be
helpful, but they can also create
dependency, Spiegel said. Furthermore, the
reviewers say that additional studies are
required to confirm this evidence and to
assess potential side effects.
The existing research also showed that paroxetine
and progestational steroids failed to
improve symptoms of tiredness. As a result,
the authors say that no evidence exists to
support their use for the treatment of
cancer-related fatigue.
As for the optimum fatigue treatment, it is still
unclear, Minton said. There is little
consensus among researchers on how to
measure fatigue, which makes gauging the
effects of medication difficult, the authors
say.
Although it is common, cancer-related fatigue is
difficult to treat effectively for all
patients all of the time. “The review looked
at one area of treatment using drugs, but
exercise and psychological interventions may
also help,” Minton said.
The most important message for patients is to be
aware of the effects of fatigue, and how
they can affect everyday life, such as
reading, self-care and daily activities,
Minton said.
“If patients start to experience these problems
having been pre-warned then it may reduce
the distress associated with fatigue. It is
worth discussing the expected symptoms and
possible treatment options with your doctors
before, during and after any treatment ends.
"Patients can experience fatigue at the time
of diagnosis, on treatment and in patients
with more advanced disease. It can also
occur after treatment — even when they are
free of cancer. There may be options for
treating it at all of these stages,” Minton
said.
Minton O, et al. Drug therapy for the management
of cancer related fatigue. (Review).
Cochrane Database of Systematic Reviews
2008, Issue 1.
The Cochrane Collaboration is an international
nonprofit, independent organization that
produces and disseminates systematic reviews
of health care interventions and promotes
the search for evidence in the form of
clinical trials and other studies of
interventions. Visithttp://www.cochrane.orgfor
more information.
