Modafinil for Cancer Patients
It is used both as a palliative and to cope with the side effects of treatment
An estimated 60% of cancer patients experience fatigue,
either from the disease itself or as a side effect of treatment. Indeed,
much of the diminishment in quality of life among cancer patients can
be attributed to constant fatigue. Treatment is different for different
people, and doctors take into account many factors when determining a
course of action. In addition to traditional therapies, such as hematopoietics,
antidepressants, corticosteroids, and psychostimulants, Modafinil
may be an option.
Occasionally, a reversible cause, such as anemia,"is discovered, and
with treatment the patient experiences significant improvement. However,
when several factors account for the fatigue, doctors often used a multimodality
approach. Provigil (modafinil) may be warranted." At the 2008 American
Society for Clinical Oncology meeting, the results
of a large study were presented, showing that Provigil was able to
help cancer patients with severe fatigue. Those with more moderate fatigue
got no improvement from the drug. In a more recent study in Germany researchers
concluded that modafinil's ability to improve brain skills and alertness
are worth pursuing
for cancer patients.
Despite its widespread occurrence, fatigue is seldom addressed in by
doctors and the field of potential treatments is still very limited. In
addition to Provigil, methylphenidate (Ritalin) is sometimes considered.
Low doses of steroids, such as dexamethasone and prednisone, are also
employed. A
study of Ritalin found it no more effective than a placebo in relieving
cancer fatigue.
One common problem in cancer treatment is "chemo brain", which
is when people undergoing chemotherapy cannot think straight. The chemotherapy
drugs sap their mental energy. More
on Modafinil and Chemo Brain.
From the National Cancer Institute:
Fatigue is among the most commonly reported symptoms of patients with
cancer, with prevalence exceeding 60% in many studies. It is among the
most distressing symptoms associated with cancer and cancer treatments
because it substantially disturbs patients' quality of life and ability
to function optimally on a daily basis. Although the development of
this condition has been associated with a number of factors, its etiology
remains poorly understood. Important elements to include in any definition
of cancer-related fatigue include its pervasiveness, persistence, detrimental
effect on quality of life, and its inability to be relieved by rest
or sleep. Several validated questionnaires can be used to measure fatigue
in patients with cancer, and research efforts are currently focused
on ways to distinguish it from depression with which it shares many
symptoms. All patients with cancer should be evaluated for fatigue,
and treatment options should be considered for those who are experiencing
excessive levels of fatigue. Treatment should be individualized according
to the underlying pathology when a specific cause has been identified
(e.g., anemia, sleep disorder, depression, or metabolic disorder). Nonspecific
therapies may be useful in short- and long-term cancer-related fatigue
management in many patients. In addition to older therapies, such as
hematopoietics, antidepressants, corticosteroids, and psychostimulants,
the effectiveness of the new wake-promoting agent modafinil is currently
being studied. A more thorough evaluation of the various therapeutic
options is required to better define their efficacy and safety profiles
in this patient population.
Although fatigue is one of the most prevalent symptoms in cancer, to
date no trials are published on the use of psychostimulants as a treatment
for fatigue in people with cancer. The support for their use arises
largely from clinical anecdotal experience.[5] Psychostimulants (caffeine,
methylphenidate, modafinil, and dextroamphetamine) given in low doses
are useful for patients who are suffering from depressed mood, apathy,
decreased energy, poor concentration, and weakness. Extensive clinical
experience with cancer patients indicates that psychostimulants promote
a sense of well-being, decreased fatigue, and increased appetite.......
********************************
Insomnia is more prevalent in cancer survivors than in the general population.
Research in cancer-related fatigue is in its infancy, and the medical
profession is still trying to figure out both pharmacologic and nonpharmacologic
treatments. Provigil may be
part of the answer, and may be one of the better tools in the arsenal
for attacking fatigue right now. The federal government is funding
research into modafinil for improving the quality of life of cancer
patients.
Related: Modafinil for
Apathy
