Psychostimulants for Cancer-Related Fatigue
Psychostimulants for Cancer-Related Fatigue
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DOI：
10.6004/jnccn.2010.0068
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发表时间：
2010-08-01
影响因子：
13.4
通讯作者：
Alici, Yesne
中科院分区：
文献类型：
--
作者：
Breitbart, William;Alici, Yesne
疲劳是一种高度流行和令人痛苦的症状，与癌症患者的显著心理和功能发病率以及生活质量下降相关。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因素，疲劳在癌症患者中未得到充分报告和认识。除了评估潜在可逆的医学原因或加重疲劳的药物，以及实施非药物干预外，还考虑了几种药物治疗方案用于治疗癌症相关疲劳。在传统的精神兴奋剂中，哌醋甲酯的研究最多，尽管有常见的副作用，但在癌症患者中有效且耐受性良好。莫达非尼是一种新的精神兴奋剂，通常被称为觉醒促进剂，也被研究过，似乎在癌症患者中耐受良好。在大多数精神兴奋剂的随机对照试验中报告了较大的安慰剂效应。因此，需要大样本量的随机安慰剂对照试验来进一步评估精神兴奋剂治疗癌症相关疲劳的疗效和耐受性。本文提出了一个全面的审查使用精神兴奋剂药物的疲劳癌症患者，包括概述的临床试验与精神兴奋剂和临床指南可用于治疗癌症相关的疲劳。（JNCCN 2010;8：933-942）
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. (JNCCN 2010;8:933-942)