GO TO CMA Home
GO TO Inside CMA
GO TO Advocacy and Communications
GO TO Member Services
GO TO Publications
GO TO Professional Development
GO TO Clinical Resources

GO TO What's New
GO TO Contact CMA
GO TO Web Site Search
GO TO Web Site Map


CMAJ
CMAJ - November 17, 1998JAMC - le 17 novembre 1998

Asthenia and paralysis

CMAJ 1998;159:1242

In response to: P.J. Potter
Our group1­4 and others5,6 have had some experience with the use of amphetamines to treat patients with metastatic cancer. Most studies have been conducted in patients with opioid-induced sedation. In this subgroup, amphetamine derivatives appear to improve significantly the level of arousal, the degree of asthenia and the overall sensation of well-being. However, these drugs have not been used in randomized controlled trials in the specific group of patients with paralysis. Dr. Potter has identified an interesting area for future research.

With regard to megestrol, our group7,8 and others9,10 have found significant objective improvement as well as nutritional improvement in some patients with metastatic cancer. Unfortunately, we are not aware of studies in the population of patients described by Potter.

Studies on the role of these 2 types of agents in patients with paralysis will probably require careful definition of outcomes and involvement by multiple groups. The encouraging results in other patient populations suggest that such trials are justified.

Eduardo Bruera, MD
Professor of Oncology
Alberta Cancer Foundation
Chair in Palliative Medicine
Grey Nuns Community Hospital
  and Health Centre
Edmonton, Alta.

Comments Send a letter to the editor
Envoyez une lettre à la rédaction

References
  1. Bruera E, Miller MJ, Macmillan K, Kuehn N. Neuropsychological effects of methylphenidate in patients receiving a continuous infusion of narcotics for cancer pain. Pain 1992;48:163-6.
  2. Bruera E, Fainsinger R, MacEachern T, Hanson J. The use of methylphenidate in patients with incident cancer pain receiving regular opiates. A preliminary report. Pain 1992;50:75-7.
  3. Watanabe S, Bruera E. Anorexia and cachexia, asthenia and lethargy. Hematol Oncol Clin North Am 1996;10(1):189-206.
  4. Bruera E, Watanabe S. Psychostimulants as adjuvant analgesics. J Pain Symptom Manage 1994;9(6):412-5.
  5. Wilwerding MB, Loprinzi CI, Mailliard JA, O'Fallon JR, Miser AW, van Haelst C, et al. A randomized, crossover evaluation of methylphenidate in cancer patients receiving strong narcotics. Support Care Cancer 1995;3(2):135-8.
  6. Yee JD, Berde CB. Dextroamphetamine or methylphenidate as adjuvants to opioid analgesia for adolescents with cancer. J Pain Symptom Manage 1994;9(2):122-5.
  7. Bruera E, Macmillan K, Hanson J, Kuehn N, MacDonald RN. A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer 1990;66:1279-82.
  8. Bruera E, Ernst S, Hagen N, Spachynski K, Belzile M, Hanson J, et al. Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Cancer Prev Control 1998;2(2):74-8.
  9. Beller E, Tattersall M, Lumley T, Levi J, Dalley D, Olver I, et al. Improved quality of life with megestrol acetate in patients with endocrine-insensitive advanced cancer: a randomised placebo-controlled trial. Australasian Megestrol Acetate Cooperative Study Group. Ann Oncol 1997;8(3):277-83.
  10. McMillan DC, O'Gorman P, Fearon KC, McArdle CS. A pilot study of megestrol acetate and ibuprofen in the treatment of cachexia in gastrointestinal cancer patients. Br J Cancer 1997;76(6):788-90.