Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review

Abstract

BackgroundIn palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases.MethodsWe considered randomized controlled trials concerning adult palliative care with a focus on pharmacological treatment of fatigue compared with placebo, application of two drugs, usual care or a non‐pharmacological intervention. The primary outcome had to be non‐specific fatigue (or related terms such as asthenia). We searched the CENTRAL, MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. Two review authors independently assessed trial quality and extracted the data.ResultsWe screened 1645 publications of which 45 met the inclusion criteria. In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials. Meta‐analysis of data was possible for modafinil, pemoline, and methylphenidate.ConclusionsDue to the limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Some drugs, which may be beneficial for the treatment of fatigue associated with palliative care such as amantadine, methylphenidate, and modafinil, should be further researched.

The Potential Role of Psychosocial Rehabilitation in Palliative Care

“…A Cochrane review and meta-analysis concluded that in the face of limited evidence, it is not possible to recommend a specifi c medication for the treatment of fatigue in palliative care. 40 Another controversial issue is the application of electroconvulsive therapy in palliative care. There are authors who argue that their use should not be completely ruled out and should be considered if it can provide a better quality of life for selected patients.…”

From meta‐analysis to Cochrane reviews

“…Based on that they showed that there is insufficient evidence to support the use of a specific medicine to treat fatigue in palliative care patients. In this regards, amantadine showed the promised benefit in patients with multiple sclerosis with fatigue and methylphenidate in patients with cancer‐related fatigue …”

“…The executive summary by Mücke et al was the second Cochrane review that was published in Journal of Cachexia, Sarcopenia and Muscle in March 2016. 7,8 The aim of the Cochrane review was to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases. A total of 1645 publications were selected during the literature search.…”

“…In this regards, amantadine showed the promised benefit in patients with multiple sclerosis with fatigue and methylphenidate in patients with cancer-related fatigue. 6,7 Connolly et al wrote the third Cochrane executive summary that was published in December 2016. 9,10 They aimed to determine the effectiveness of exercise rehabilitation initiated after intensive care unit discharge on primary outcomes of functional exercise capacity and health-related quality of life.…”

Auricular acupressure: reducing side effects of chemotherapy in women with ovarian cancer

“…The effectiveness and safety of pharmacological and non-pharmacological interventions to alleviate side-effects have been carefully examined. According to a recent Cochrane Review of 45 randomized controlled trials (RCTs) with 4,696 participants, there was insufficient evidence to support the use of prescription medication (such as amantadine, modafinil, and methylphenidate) to treat cancer-related fatigue [8]. In contrast, a systematic review of -2 -11 RCTs showed that complex nursing interventions (including patient education, symptom assessment, counseling and coaching) produced clinically important reductions in chemotherapy-related burden of side-effects by 10-88% [9].…”