Wednesday, September 17, 2008

Review of Cancer Fatigue Therapy

JNCI has a metaanalysis of the pharmacologic treatment of cancer related fatigue. Most interesting was that it pools data on the two randomized, placebo-controlled trials looking at methylphenidate for cancer fatigue (one from a 'palliative care' population which we blogged about before and the other a breast cancer chemotherapy population...I can't find the actual paper referenced in the article but it appears to be regarding this trial). Even though the palliative care population article was negative, and showed no treatment benefit for methylphenidate over placebo (there was a trend towards benefit but it wasn't statistically significant), when those data were combined with the other trial the authors of the metaanalysis concluded that indeed methylphenidate is effective. (The data could be combined relatively easily as both trials used the same outcome measure.)

I didn't stop using methylphenidate when the negative trial came out: not because I didn't believe the study results but because I had enough patients who responded/benefited (even if it was a placebo effect) that I chalked up the negative findings to the fact that many patients don't respond at all, and for many who do the effect is modest. That said, it's nice to see that perhaps the door wasn't shut on methylphenidate, as trite as that can sound based on a metaanalysis of two trials!

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