Chang Young D, Smith Joshua, Portman Diane, Kim Richard, Oberoi-Jassal Ritika, Rajasekhara Sahana, Davis Mellar
1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.
2 Palliative Medicine, Geisinger Medical Center, Danville, PA, USA.
Am J Hosp Palliat Care. 2018 Jan;35(1):144-150. doi: 10.1177/1049909117695733. Epub 2017 Mar 16.
Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown.
The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy.
We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents.
We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue (cutoff value: ≥3; reduction in fatigue score from baseline: 80% ≥2, 60% ≥3, and 46.7% ≥4).
In our retrospective medical record review, the combination treatment of methylphenidate and AG had no discernible associated toxicities and showed potential clinical benefit in CRF.
哌醋甲酯或西洋参单一疗法通过不同的药理机制有助于减轻癌症相关疲劳（CRF），且相对安全。然而，哌醋甲酯与西洋参联合治疗CRF的安全性和有效性尚不清楚。
主要目的是评估哌醋甲酯与西洋参联合治疗干预后，采用埃德蒙顿症状评估量表（ESAS）上的数字评定量表（NRS）评估临床安全性及疲劳变化情况。
我们回顾了2015年2月1日至2015年12月31日期间在我们姑息医学门诊就诊的857例患者的电子病历。通过ESAS上的NRS评估疲劳情况。根据临床医生记录评估毒性。
我们确定了28例患者接受哌醋甲酯（10 - 40毫克/天）和西洋参（2000毫克/天）联合治疗。10例患者未遵行联合治疗。3例患者出现2级不良反应。15例患者按医嘱完成了规定的联合治疗。干预前后随访的平均时间间隔为30.5天（标准差[SD]：7.78）。从评分前记录到评分后记录，疲劳评分显著降低（平均评分从6.93降至4.13）（平均值：-2.8；SD：1.61；P <.0002*[*表示具有统计学意义]）。60%的患者报告疲劳显著减轻（临界值：≥3；疲劳评分较基线降低：80%≥2，60%≥3，46.7%≥4）。
在我们的回顾性病历审查中，哌醋甲酯与西洋参联合治疗没有明显的相关毒性，并且在CRF中显示出潜在的临床益处。
