Using aggregated single patient (N-of-1) trials to determine the effectiveness of psychostimulants to reduce fatigue in advanced cancer patients: a rationale and protocol

BMC Palliative Care

Study Protocol

Rohan Vora¹  Janet R Hardy²  Phillip D Good³  Sue-Ann Carmont⁴  Jane Nikles⁴  Geoffrey K Mitchell⁴  Hugh EJ Senior⁴  Meera Agar⁵  David C Currow⁵  Philip J Schluter⁶  Michael J Yelland⁷ 

[1] Department of Palliative Care, Gold Coast Hospital, Gold Coast, Queensland, Australia;Department of Palliative Care, Mater Health Services, Brisbane, Queensland, Australia;Department of Palliative Care, St. Vincent‘s Hospital, Brisbane, Queensland, Australia;Department of Palliative Care, Mater Health Services, Brisbane, Queensland, Australia;Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia;Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia;School of Health Sciences, University of Canterbury, Christchurch, New Zealand;School of Nursing and Midwifery, The University of Queensland, Brisbane, Queensland, Australia;School of Medicine, Griffith University, Gold Coast, Queensland, Australia;

关键词: Fatigue;    Cancer;    Methylphenidate hydrochloride;    N-of-1 trial;    Single patient trial;    Palliative;   

DOI  :  10.1186/1472-684X-12-17

 received in 2013-03-18, accepted in 2013-04-16,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundIt is estimated that 29% of deaths in Australia are caused by malignant disease each year and can be expected to increase with population ageing. In advanced cancer, the prevalence of fatigue is high at 70–90%, and can be related to the disease and/or the treatment. The negative impact of fatigue on function (physical, mental, social and spiritual) and quality of life is substantial for many palliative patients as well as their families/carers.Method/designThis paper describes the design of single patient trials (n-of-1 s or SPTs) of a psychostimulant, methylphenidate hydrochloride (MPH) (5 mg bd), compared to placebo as a treatment for fatigue, with a population estimate of the benefit by the aggregation of multiple SPTs. Forty patients who have advanced cancer will be enrolled through specialist palliative care services in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 6 days long and has 3 days treatment and 3 days placebo. The order of treatment and placebo is randomly allocated for each cycle. The primary outcome is a reduction in fatigue severity as measured by the Functional Assessment of Cancer Therapy-fatigue subscale (FACIT-F). Secondary outcomes include adverse events, quality of life, additional fatigue assessments, depression and Australian Karnovsky Performance Scale.DiscussionThis study will provide high-level evidence using a novel methodological approach about the effectiveness of psychostimulants for cancer-related fatigue. If effective, the findings will guide clinical practice in reducing this prevalent condition to improve function and quality of life.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12609000794202

【 授权许可】

CC BY   
© Senior et al.; licensee BioMed Central Ltd. 2013