Psychiatry Service, Department of Psychiatry & Behavioral Sciences, and Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Natl Compr Canc Netw. 2010 Aug;8(8):933-42. doi: 10.6004/jnccn.2010.0068.
Fatigue is a highly prevalent and distressing symptom associated with significant psychological and functional morbidity and decreased quality of life among patients with cancer. Despite its impact on patients and caregivers, fatigue is underreported and underrecognized, and remains untreated among patients with cancer because of various patient- and clinician-related factors. In addition to assessment for potentially reversible medical causes or medications exacerbating fatigue, and the implementation of nonpharmacologic interventions, several pharmacologic treatment options have been considered for the treatment of cancer-related fatigue. Among traditional psychostimulants, methylphenidate has been studied the most and is effective and well tolerated among patients with cancer despite common side effects. Modafinil, a novel psychostimulant commonly referred to as wakefulness-promoting agents as a group, has also been studied and seems to be well tolerated among patients with cancer. A large placebo effect has been reported in most randomized controlled trials with psychostimulants. Thus, randomized placebo-controlled trials with large sample sizes are needed to further assess the efficacy and tolerability of psychostimulants in the treatment of cancer-related fatigue. This article presents a comprehensive review of the use of psychostimulant agents for fatigue among patients with cancer, including an overview of the clinical trials with psychostimulants and of the clinical guidelines available for treatment of cancer-related fatigue.
疲劳是一种普遍存在且令人痛苦的症状，与癌症患者的显著心理和功能发病率以及生活质量下降有关。尽管疲劳对患者和护理人员有影响，但由于各种患者和临床医生相关的因素，疲劳的报告和认识不足，并且在癌症患者中仍然未得到治疗。除了评估可能导致疲劳的潜在可逆转的医学原因或药物，并实施非药物干预外，还考虑了几种药物治疗选择来治疗癌症相关的疲劳。在传统的精神兴奋剂中，哌醋甲酯研究最多，并且在癌症患者中有效且耐受良好，尽管存在常见的副作用。莫达非尼，一种新型的精神兴奋剂，通常被称为一组促进觉醒的药物，也已被研究，并在癌症患者中似乎耐受良好。大多数随机对照试验报告了很大的安慰剂效应。因此，需要进行更大样本量的随机安慰剂对照试验，以进一步评估精神兴奋剂在治疗癌症相关疲劳中的疗效和耐受性。本文全面回顾了癌症患者使用精神兴奋剂治疗疲劳的情况，包括精神兴奋剂的临床试验概述以及治疗癌症相关疲劳的现有临床指南。
