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Efficacy of pharmacological treatments for fatigue associated with advanced disease

Peuckmann-Post V, Elsner F, Krumm N, Trottenberg P, Radbruch L
Published Online: 
8 December 2010

Fatigue in advanced disease such as cancer can be described as a subjective feeling of tiredness, weakness, or lack of energy. It is debilitating, impacting daily activity and quality of life, and continues to be a frequent challenge in palliative care. Underlying mechanisms are still not understood, which complicates its treatment. Although various pharmacological approaches have been examined, it has not been possible to recommend a specific treatment for fatigue based on scientific evidence. In this review, we aimed to identify substances that alleviate fatigue in advanced disease. We identified 22 studies for analysis, reporting fatigue treatment in 1632 participants, examining neurological diseases (multiple sclerosis (10), postpolio syndrome (1)), different types of cancer (6), HIV (4), and end-stage chronic lung disease (1). The identified therapeutic drugs can be considered as drugs interacting with the central nervous system, hormones, anti-inflammatory substances, or food supplement. Unfortunately, most studies included relatively small numbers of participants and research methodology was often heterogenous, resulting in weak and inconclusive data. Thus, based on the limited evidence, the authors still cannot recommend a specific drug for the treatment of fatigue in palliative care, although amantadine in multiple sclerosis and methylphenidate in cancer patients showed a superior effect. Interestingly, the literature search did not reflect the common clinical practice of using corticosteroids (drugs interacting with the immune system) for the treatment of fatigue in palliative care, since there was a lack of such studies. However, future research on psychostimulants and corticosteroids may be promising. In addition, consensus is needed concerning the measurement of fatigue in advanced disease (e.g. which scale should be used).

This record should be cited as: 
Peuckmann-Post V, Elsner F, Krumm N, Trottenberg P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD006788. DOI: 10.1002/14651858.CD006788.pub2
Assessed as up to date: 
6 October 2010