与晚期癌症患者对哌醋甲酯反应相关的因素。
Factors associated with response to methylphenidate in advanced cancer patients.
机构信息
Department of Palliative Care and Rehabilitation Medicine, Unit 008, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
出版信息
Oncologist. 2011;16(2):246-53. doi: 10.1634/theoncologist.2010-0214. Epub 2011 Jan 31.
BACKGROUND
There has been increasing interest in the use of methylphenidate for cancer-related fatigue (CRF) in patients with advanced cancer. However, there is limited literature on the specific patient characteristics associated with response to methylphenidate. Our objective of this study was to identify the specific patient characteristics associated with response to methylphenidate and to compare day 1 response with day 8 response.
METHODS
We retrospectively reviewed the records of patients in two prospective controlled clinical trials that we had conducted who had received methylphenidate for cancer-related fatigue. Baseline patient characteristics, symptoms (as assessed by the Edmonton Symptom Assessment System [ESAS] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate on day 8.
RESULTS
A total of 82 patients with advanced cancer who received methylphenidate for CRF were included in our review. The median age was 55 years, 66% were female, 74% were white, and the most common cancer type was breast (37%). Fifty out of 82 patients (61%) responded to methylphenidate (≥ 7 points in FACIT-F). The intensity of baseline fatigue positively correlated with the response to methylphenidate (p < .001). Change in fatigue in response to methylphenidate was not associated with intensity of baseline depression, anxiety, drowsiness, or daily opioid dose. Better improvement of fatigue after treatment on day 1 was associated with more improvement with fatigue on day 8 as assessed by FACIT-F (p = .0004) and ESAS (p = .0001). Day 1 response as a predictor of day 8 response had a sensitivity of 0.84, a positive predictive value of 0.67, and specificity of 0.6.
CONCLUSIONS
Response to methylphenidate is associated with higher baseline fatigue but not with higher baseline depression or sedation. Additionally, day 1 improvement is highly sensitive as a predictor of long-term improvement.
背景
在晚期癌症患者中，使用哌醋甲酯治疗癌因性疲乏（CRF）的兴趣日益增加。然而，关于哌醋甲酯治疗反应相关的具体患者特征的文献有限。本研究的目的是确定与哌醋甲酯治疗反应相关的具体患者特征，并比较第 1 天和第 8 天的反应。
方法
我们回顾性分析了我们进行的两项前瞻性对照临床试验中接受哌醋甲酯治疗癌因性疲劳的患者的记录。分析基线时的患者特征、症状（采用埃德蒙顿症状评估系统[ESAS]和慢性疾病治疗疲劳功能评估量表[FACIT-F]评估）以及治疗第 1 天结束时的反应（疲劳变化），以确定它们与第 8 天哌醋甲酯治疗反应的关系。
结果
共纳入 82 例接受哌醋甲酯治疗 CRF 的晚期癌症患者。中位年龄为 55 岁，66%为女性，74%为白人，最常见的癌症类型是乳腺癌（37%）。82 例患者中有 50 例（61%）对哌醋甲酯有反应（FACIT-F 评分≥7 分）。基线疲劳的强度与哌醋甲酯的反应呈正相关（p<0.001）。哌醋甲酯治疗反应的疲劳变化与基线抑郁、焦虑、嗜睡或每日阿片类药物剂量的强度无关。治疗第 1 天疲劳改善程度与治疗第 8 天疲劳改善程度（FACIT-F：p=0.0004；ESAS：p=0.0001）相关。第 1 天的反应作为第 8 天反应的预测指标，其敏感性为 0.84，阳性预测值为 0.67，特异性为 0.6。
结论
哌醋甲酯的治疗反应与基线时更高的疲劳程度相关，但与更高的基线抑郁或镇静程度无关。此外，第 1 天的改善是长期改善的高度敏感预测指标。
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