clinical research that might have relevance to clinical cancer dyspnea, and it is an intervention study.

CURRENTLY FUNDED CLINICAL TRIALS There are no current trials for dyspnea.

Fatigue

Fatigue is the most common symptom among cancer patients (Glaus et al., 1996). Overwhelming fatigue often characterizes patients with far advanced cancer. Because of its prevalence, it is often reported as the symptom that is the most distressing and causes the greatest interference with daily life (Richardson, 1995). Fatigue in cancer patients is associated with psychological disturbance, symptom distress, and decreases in functional status (Irvine et al., 1994).

Symptomatic treatment of fatigue is in its infancy. Severe fatigue is associated with low levels of hemoglobin (Cleeland and Wang, 1999). Fatigue caused by anemia improves if the anemia can be treated with transfusions or epoietin alfa (Glaspy et al., 1997; Demetri et al., 1998). Therapies used for fatigue include changes in a patient’s drug regimen, correction of metabolic abnormalities, and treatments for depression or insomnia. Many health care professionals suggest mild exercise as a way of dealing with fatigue, and a reduction in muscle mass has been suggested as a mechanism for fatigue. A recent controlled study found that aerobic exercise prevented increases in fatigue and psychological distress in patients undergoing highdose chemotherapy (Dimeo et al., 1999). Other nonpharmacological treatments include modification of activity and rest patterns, cognitive therapies, behavioral therapies to modify sleep (sleep hygiene), and nutritional support.

Pharmacologic treatments currently used to treat fatigue include psychostimulant drugs and corticosteroids, which are supported by very limited research (Portenoy and Itri, 1999). It has been suggested that the selective serotonin reuptake inhibitor (SSRI) antidepressants may have a role in fatigue management, but there are no reports of clinical trials of these agents for fatigue. Informal surveys that the authors have conducted at meetings indicate that many oncologists are prescribing stimulants, primarily methylphenidate, to help their patients combat debilitating fatigue, although this practice is not supported by evidence from published clinical trials. However, methylphenidate has been shown in trials to improve opioid sedation used to manage cancer pain (Bruera et al., 1992a, 1992b) and, as already mentioned, has been shown to improve cognitive function in patients with central nervous system tumors (Meyers et al., 1998).

Fatigue may be caused by the cancer itself, or like other symptoms, it



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