Open AccessFactors Associated with Response to Methylphenidate in Advanced Cancer Patients
Author(s) -
Yennurajalingam Sriram,
Palmer J. Lynn,
Chacko Ray,
Bruera Eduardo
Publication year - 2011
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2010-0214
Subject(s) - methylphenidate , medicine , anxiety , cancer related fatigue , depression (economics) , breast cancer , clinical trial , prospective cohort study , cancer , physical therapy , psychiatry , attention deficit hyperactivity disorder , economics , macroeconomics
Learning Objectives After completing this course, the reader will be able to: Identify the specific patient characteristics associated with response to methylphenidate as treatment for cancer‐related fatigue. Compare day 1 patient response to methylphenidate to day 8 response and evaluate as a predictor of long‐term improvement.This article is available for continuing medical education credit at CME.TheOncologist.comBackground. There has been increasing interest in the use of methylphenidate for cancer‐related fatigue (CRF) in patients with advanced cancer. However, there is limited literature on the specific patient characteristics associated with response to methylphenidate. Our objective of this study was to identify the specific patient characteristics associated with response to methylphenidate and to compare day 1 response with day 8 response. Methods. We retrospectively reviewed the records of patients in two prospective controlled clinical trials that we had conducted who had received methylphenidate for cancer‐related fatigue. Baseline patient characteristics, symptoms (as assessed by the Edmonton Symptom Assessment System [ESAS] and Functional Assessment of Chronic Illness Therapy‐Fatigue [FACIT‐F]), and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate on day 8. Results. A total of 82 patients with advanced cancer who received methylphenidate for CRF were included in our review. The median age was 55 years, 66% were female, 74% were white, and the most common cancer type was breast (37%). Fifty out of 82 patients (61%) responded to methylphenidate (≥7 points in FACIT‐F). The intensity of baseline fatigue positively correlated with the response to methylphenidate ( p < .001). Change in fatigue in response to methylphenidate was not associated with intensity of baseline depression, anxiety, drowsiness, or daily opioid dose. Better improvement of fatigue after treatment on day 1 was associated with more improvement with fatigue on day 8 as assessed by FACIT‐F ( p = .0004) and ESAS ( p = .0001). Day 1 response as a predictor of day 8 response had a sensitivity of 0.84, a positive predictive value of 0.67, and specificity of 0.6. Conclusions. Response to methylphenidate is associated with higher baseline fatigue but not with higher baseline depression or sedation. Additionally, day 1 improvement is highly sensitive as a predictor of long‐term improvement.