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Review

Pharmacologic Interventions for Fatigue in Cancer and Transplantation: A Meta-Analysis

1
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
2
Pediatric Oncology Group of Ontario, Toronto, ON, Canada
3
Department of Pediatric Psychology, Children’s Hospital, London Health Sciences Centre, London, ON, Canada
4
Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
5
Centre for Outcomes and Experiences Research in Children’s Health, Illness, and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK and School of Health Sciences, University of Surrey, Guildford, UK
6
University Hospital Essen, Center for Child and Adolescent Medicine, Department of Pediatric Hematology/ Oncology, Essen, Germany
7
Department of Nursing Science, Professional Practice, and Quality, Children’s National Health System; and Department of Pediatrics, George Washington University, Washington, DC, USA
8
Division of Pediatrics, Wilhelmina Children’s Hospital (part of umc Utrecht), Utrecht, the Netherlands
9
Department of Pharmacy, The Hospital for Sick Children; and Leslie Dan Faculty of Pharmacy, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
10
Division of Haematology/ Oncology, The Hospital for Sick Children, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2018, 25(2), 152-167; https://doi.org/10.3747/co.25.3883
Received: 4 January 2018 / Revised: 2 February 2018 / Accepted: 1 March 2018 / Published: 1 April 2018

Abstract

Background: Our objective was to determine whether, compared with control interventions, pharmacologic interventions reduce the severity of fatigue in patients with cancer or recipients of hematopoietic stem-cell transplantation (HSCT). Methods: For a systematic review, we searched medline, embase, the Cochrane Central Register of Controlled Trials, CINAHL, and PsychINFO for randomized trials of systemic pharmacologic interventions for the management of fatigue in patients with cancer or recipients of HSCT. Two authors independently identified studies and abstracted data. Methodologic quality was assessed using the Cochrane Risk of Bias tool. The primary outcome was fatigue severity measured using various fatigue scales. Data were synthesized using random-effects models. Results: In the 117 included trials (19,819 patients), the pharmacologic agents used were erythropoietins (n = 31), stimulants (n = 19), L-carnitine (n = 6), corticosteroids (n = 5), antidepressants (n = 5), appetite stimulants (n = 3), and other agents (n = 48). Fatigue was significantly reduced with erythropoietin [standardized mean difference (SMD): −0.52; 95% confidence interval (ci): −0.89 to −0.14] and with methylphenidate (SMD: −0.36; 95% CI: −0.56 to −0.15); modafinil (or armodafinil) and corticosteroids were not effective. Conclusions: Erythropoietin and methylphenidate significantly reduced fatigue severity in patients with cancer and in recipients of HSCT. Concerns about the safety of those agents might limit their usefulness. Future research should identify effective interventions for fatigue that have minimal adverse effects.
Keywords: pharmacologic agents; fatigue; meta-analyses; drugs; cancer-related fatigue; erythropoietin; stimulants; corticosteroids pharmacologic agents; fatigue; meta-analyses; drugs; cancer-related fatigue; erythropoietin; stimulants; corticosteroids

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MDPI and ACS Style

Tomlinson, D.; Robinson, P.D.; Oberoi, S.; Cataudella, D.; Culos-Reed, N.; Davis, H.; Duong, N.; Gibson, F.; Götte, M.; Hinds, P.; Nijhof, S.L.; van der Torre, P.; Cabral, S.; Dupuis, L.L.; Sung, L. Pharmacologic Interventions for Fatigue in Cancer and Transplantation: A Meta-Analysis. Curr. Oncol. 2018, 25, 152-167. https://doi.org/10.3747/co.25.3883

AMA Style

Tomlinson D, Robinson PD, Oberoi S, Cataudella D, Culos-Reed N, Davis H, Duong N, Gibson F, Götte M, Hinds P, Nijhof SL, van der Torre P, Cabral S, Dupuis LL, Sung L. Pharmacologic Interventions for Fatigue in Cancer and Transplantation: A Meta-Analysis. Current Oncology. 2018; 25(2):152-167. https://doi.org/10.3747/co.25.3883

Chicago/Turabian Style

Tomlinson, D., P. D. Robinson, S. Oberoi, D. Cataudella, N. Culos-Reed, H. Davis, N. Duong, F. Gibson, M. Götte, P. Hinds, S. L. Nijhof, P. van der Torre, S. Cabral, L. L. Dupuis, and L. Sung. 2018. "Pharmacologic Interventions for Fatigue in Cancer and Transplantation: A Meta-Analysis" Current Oncology 25, no. 2: 152-167. https://doi.org/10.3747/co.25.3883

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