Uso del metilfenidato en pacientes con cáncer avanzado

Mercedes Patricia Papa

Authors

Mercedes Patricia Papa Universidad de la República, Facultad de Medicina, Departamento y Cátedra de Anestesiología. Prof. Adjunto

Keywords:

METHYLPHENIDATE, DEPRESSION, DELIRIUM, FATIGUE, NEOPLASMS, PALLIATIVE CARE

Abstract

Introduction: Cancer, both the disease and its treatment are associated with a series of physical and psychosocial symptoms such as fatigue, depression, drowsiness and hypoactive delirium that need to be identified and treated in order to optimize the patients' quality of life.
Methylphenidate, a psychostimulant drug used for the attention deficit disorder, is used within the context of palliative medicine to control these symptoms in patients suffering from advanced cancer.
Objectives: The present articles aims to explore the evidence that justifies the use of this drug in the symptomatic handling of oncological patients, as well as its efficacy and safety in this population.
Method: We conducted a search in the Medline, Pubmed y Embase databases, both in English and in Spanish, from 1990 until today.
Conclusions: Methylphenidate is the most widely used psychostimulant in palliative medicine. As it increases the level of brain alert it results in a potential benefit for the handling of symptoms in patients with advanced cancer, such as the cancer associated fatigue, sedation associated to the use of opioids, depression and hypoactive delirium.

References

(1) Hardy SE. Methylphenidate for the treatment of depressive symptoms, apathy and fatigue in medically Ill older adults and terminally Ill adults. Am J Geriatr Pharmacother 2009; 7(1):34-59.
(2) Jensen PS. Review: methylphenidate and psychosocial treatments either alone or in combination reduce ADHD symptoms. Evid Based Ment Health 2009; 12 (1):18.
(3) 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(1):75-7.
(4) Breitbart W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 1995; 3(1):45-60.
(5) Elie D, Gagnon P, Gagnon B, Giguère A. Using psychostimulants in end-of-life patients with hypoactive delirium and cognitive disorders: a literature review. Can J Psychiatry 2010; 55(6):386-93.
(6) Portela MA, Sanz A, Martínez M, Centeno C. Astenia en cáncer avanzado y uso de psicoestimulantes. Anales Sis San Navarra 2011; 34(3):471-9.
(7) Prommer E. Methylphenidate: established and expanding roles in symptom management. Am J Hosp Palliat Care 2012; 29(6):483-90.
(8) Rozans M, Dreisbach A, Lertora JJ, Kahn MJ. Palliative uses of methylphenidate in patients with cancer: a review. J Clin Oncol 2002; 20(1):335-9.
(9) Sood A, Barton DL, Loprinzi CL. Use of methylphenidate in patients with cancer. Am J Hosp Palliat Care 2006; 23(1):35-40.
(10) Sweeney C, Bogan C. Assessment and management of opioids side effects. En: Bruera E, Higginson I, Ripamonti C, von Gunten Ch, eds. Textbook of palliative medicine. London: Hodder Arnold, 2006. p. 390-401.
(11) Wilwerding MB, Loprinzi CL, 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.
(12) Stone P, Minton O. European Palliative Care Research collaborative pain guidelines. Central side-effects management: what is the evidence to support best practice in the management of sedation, cognitive impairment and myoclonus? Palliat Med 2011; 25(5):431-41.
(13) National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: palliative care, Version 2. 2011. Fort Washington: NCCN, 2012.
(14) Fisch M. Treatment of depression in cancer. J Natl Cancer Inst Monogr 2004;(32):105-11.
(15) Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, et al. The prevalence of psychiatric disorders among cancer patients. JAMA 1983; 249(6):751-7.
(16) Fish M. Depression/anxiety. Enn: Bruera E, Higginson I, Ripamonti C, von Gunten Ch, eds. Textbook of Palliative Medicine. London: Hodder Arnold, 2006. p. 675-87.
(17) Bruera E, Valero V, Driver L, Shen L, Willey J, Zhang T, et al. Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. J Clin Oncol 2006; 24(13):2073-8.
(18) Olin J, Masand P. Psychostimulants for depression in hospitalized cancer patients. Psychosomatics 1996; 37(1):57-62.
(19) Centeno C, Sanz A, Cuervo MA, Ramos D, Hernansanz S, González J, et al. Multicentre, double-blind, randomised placebo-controlled clinical trial on the efficacy of methylphenidate on depressive symptoms in advanced cancer patients. BMJ Support Palliat Care Published Online First: 31 May 2012.
(20) American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington, DC: American Psychiatric Association, 1994. p. 123-33.
(21) Centeno C, Sanz A, Bruera E. Delirium in advanced cancer patients. Palliat Med 2004; 18(3):184-94.
(22) Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 2000; 160(6):786-94.
(23) Breitbart W, Friedlander M. Confusion/Delirium. In: Bruera E, Higginson I, Ripamonti C, von Gunten Ch, eds. Textbook of Palliative Medicine. London, Hodder Arnold 2006. p. 688-700.
(24) Escalante CP, Manzullo EF. Cancer-related fatigue: the approach and treatment. J Gen Intern Med 2009; 24(Suppl 2):S412-6.
(25) Minton O, Richardson A, Sharpe M, Hotopf M, Stone PC. Psychostimulants for the management of cancer-related fatigue: a systematic review and meta-analysis. J Pain Symptom Manage 2011; 41(4):761-7.
(26) Portenoy RK, Itri LM. Cancer-related fatigue: guidelines for evaluation and management. Oncologist 1999; 4(1):1-10.
(27) Breitbart W, Alici Y. Psychostimulants for cancer-related fatigue. J Natl Compr Canc Netw 2010; 8(8):933-42.
(28) Yennurajalingam S, Palmer JL, Chacko R, Bruera E. Factors associated with response to methylphenidate in advanced cancer patients. Oncologist 2011; 16(2):246-53.