Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial
I guess scalp cooling does have some objective evidence that it works. Still the expense and time constraints will need to be considered.
Methylphenidate Versus Placebo for Treating Fatigue in Patients With Advanced Cancer: Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial
Author(s): Patrick Charles Stone, MD, MA, MRCP1; Ollie Minton, PhD, FRCP, FHEA2; Alison Richardson, PhD, MSc, BN (Hons), PGDipEd, RGN3; Peter Buckle1; Zinat E. Enayat, PhD, MSc, BSc1; Louise Marston, PhD, MSc, BSc4; Nick Freemantle, PhD, MA(Dist), BA(Hons)4
Source: https://doi.org/10.1200/JCO.23.02639
Dr. Anjan Patel's Thoughts
Stimulant therapy with methylphenidate did not improve fatigue in a well-done, prospective, placebo-controlled trial. This refutes prior practices of using ADD medications to mitigate fatigue for patients on chemotherapy. I rarely use these in my own practice given the concern for weight loss and mood disorder.
PURPOSE
To compare effects and side effects of 6 weeks of individually dose-titrated methylphenidate or placebo on fatigue in palliative care patients with advanced cancer.
METHODS
This is a randomized, double-blind, placebo-controlled, multicenter trial. Eligible patients had advanced incurable cancer and fatigue >3/10. Principal exclusions were hypertension; psychiatric, cardiovascular, cerebrovascular, renal, liver, or blood disorders; substance dependency; and epilepsy. Patients were randomly assigned 1:1 methylphenidate or placebo starting at 5 mg twice daily. Dose of methylphenidate/placebo was titrated once per week, over 6 weeks, up to a maximum of 20 mg three times daily. Trial ended at 10 weeks. Primary outcome was the difference in Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) scores between groups at 6 ± 2 weeks. Secondary outcomes included adverse effects, quality of life, and mood.
RESULTS
One hundred sixty-two patients (73 men; mean, 65.8; standard deviation [SD], 10.3 years) were randomly assigned, and three were excluded from analysis. Seventy-seven were allocated placebo (baseline FACIT-F = 22 [SD, 10]); 82 were allocated methylphenidate (FACIT-F = 20 [SD, 9]). After 6 ± 2 weeks, FACIT-F scores were 1.97 points (95% CI, –0.95 to 4.90; P = .186) higher (better) on methylphenidate than placebo. Across 10 weeks of the study, FACIT-F was nominally higher in the methylphenidate group versus placebo (Diff, 2.20 [95% CI, 0.39 to 4.01]), but this did not reach the minimally clinically important difference (5-points). At 6 weeks, there were no differences between groups in quality-of-life or symptom domains except for depression scores (nominally reduced in the methylphenidate group: Diff, –1.35 [95% CI, –2.41 to –0.30]). There were no differences in mortality or serious adverse events.
CONCLUSION
After 6 ± 2 weeks of treatment, methylphenidate was not superior to placebo for treating fatigue in advanced cancer. Methylphenidate was safe and well-tolerated.
Author Affiliations
1Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, United Kingdom; 2University Hospitals Sussex NHS Foundation Trust, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, United Kingdom; 3University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, United Kingdom; 4Department of Primary Care & Population Health, Institute of Epidemiology & Health Care, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom; 5Comprehensive Clinical Trials Unit, University College London (UCL), London, United KingdomRelated Articles
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