Tired? Is there anything to do?
Submitted by Dr.Kattlove’s Cancer Blog
Many patients with wide spread cancer find that they tire easily and, in fact, wake up tired. If they are on chemotherapy, fatigue will take over even if their cancer hasn’t spread. Recently, a group of British doctors surveyed the world’s literature to see if anything has been discovered that would perk up these people with cancer.
Surprisingly the single drug that seems to work the best and is the simplest is methylphenidate, better known as Ritalin. This is basically a stimulant like Dexedrine and maybe even like methamphetamine (the “meth” that lots of drug users like). And, the drug can be addicting. Who doesn’t want to feel full of energy? But for some cancer patients it seems a blessing. I remember one story of a pediatrician with lung cancer, who felt that Ritalin brought him back to life. Even though he had a terminal illness, he was at least able to “live” his last few months.
The Brits also found that the drug erythropoietin, which stimulates the body to make red blood cells, was also effective in bumping up patients’ energy levels, but only if they were anemic. Surprisingly, the latest version of erythropoietin, darbopoietin wasn’t able to help tired patients. This may be that the studies were done more carefully and patients’ were better evaluated, because of the controversy surrounding these drugs.
What’s the controversy about erythropoietin and darbopoietin? First, they are very expensive and need to be given by injection, often in the doctor’s office. Second people who receive these drugs tend to develop blood clots. Finally, their cancer may grow faster when they receive these drugs. Some studies have actually shown that patients receiving these drugs may have a shorter life span. That is why the FDA has clamped down on their use and added a black box to the label.
Two other drugs were also looked at. One was progesterone, a female hormone that will sometimes increase patients’ appetites. The second was Prozac, an antidepressant. Neither worked.
The bottom line with all this is fighting fatigue caused by cancer or chemotherapy is tough. My own choice is Ritalin. It is cheap and being a pill, is easy to take. Can someone get addicted? I think that is a myth like the reason doctors and patients are reluctant to use morphine for cancer pain. I never had a patient become addicted to morphine. When the pain went away because of treatment, the morphine got flushed down the toilet.
The same is true of the concern about getting addicted to Ritalin. It doesn’t happen in cancer patients. And, if a patient’s energy comes back, then the Ritalin will be dumped.
Furthermore, if you have a life-threatening disease, it isn’t worth worrying about.
