The agony & the ecstasy of EBM in symptom management

So, I decided I might blog a little again. Probably the occasional Journal Club of the Cloud-type posts. Christian and fellow bloggers, thank you for all you do in keeping Pallimed thriving and relevant. So, Eduardo Bruera & colleagues at MD Anderson have published the results of their long-awaited follow-up trial to their 2006 double-blinded, placebo controlled trial suggesting that methylphenidate (MP) is no better than placebo for cancer-related fatigue (CRF). Original 2006 trial here New 2013 trial here Journal of Clinical Oncology editorial on the 2013 trial here (hat tip to this editorial for pointing out some of the recent MP trials mentioned below) In the 2006 trial, most patients had a marked improvement in fatigue across the 2 weeks of the trial. This lead the investigators to hypothesize that perhaps it was the frequent research nurse calls, that both the active and placebo groups received, that caused the fatigue to improve. Thus, the 2013 trial is really a 2x2 trial comparing both methylphenidate and placebo, as well as a nursing telephone intervention vs a control telephone intervention (ie there were 4 groups: MP + nursing call, MP + control calls, placebo + nursing call , placebo+control calls). The investigators and patients were blinded to allocation. Notably, the main drug intervention was giving patients 5mg MP tabs (or matching placebo), and encouraging them to use it q2h prn, up to 4 doses a day, for fatigue. This is the identical p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Carer Workers Authors: Source Type: blogs