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    Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention

    Table 2. Centrally Acting Stimulants for Adult Cancer Patients continued...

    One limitation of this study was that it was only 2 weeks long, and longer-term use of dexamethasone is well known to be associated with unwanted side effects. Therefore, the risk versus benefit of treating fatigue with dexamethasone for more than 2 weeks requires investigation. Because fatigue has been associated with high levels of inflammation, this study is noteworthy in its evaluation of dexamethasone as an anti-inflammatory agent to alleviate fatigue.[31] The investigators did not assess inflammatory biomarkers; therefore, the proof of concept that modifying inflammation can reduce fatigue needs replication.

    Dietary supplements

    Dietary supplements comprise other, often popular, pharmacologic interventions for CRF.

    L-carnitine

    L-carnitine is a widely used dietary supplement believed to be helpful for the treatment of CRF because of its role in cellular energy metabolism and carnitine's ability to decrease pro-inflammatory cytokines. Promising pilot data led to the development and completion of a large (N = 376) phase III study in a multisite cooperative group setting. Participants with moderate to severe fatigue were randomly assigned to receive either 10 g levocarnitine or a placebo for 4 weeks. The primary endpoint was change in average fatigue. Despite increases in mean levels of L-carnitine, there was not a statistically significant difference in fatigue between arms, with both arms reporting improved fatigue during the study.[32]

    Ginseng

    Ginseng, another popular supplement used to treat fatigue, has also been the subject of evaluation in large, multisite clinical trials. On the basis of a promising phase II dose-finding study,[33] a phase III, randomized, placebo-controlled trial was completed involving 364 patients with cancer who either were undergoing anticancer treatment or had completed treatment. Participants were randomly assigned to receive either 2,000 mg of American ginseng (specifically, Wisconsin ginseng) in the form of ground root in a capsule or a matching placebo. The primary endpoint was change in fatigue scores as measured by the Multidimensional Fatigue Symptom Inventory-Short Form. At 4 weeks, the group receiving ginseng showed a trend toward significant improvement, while at 8 weeks, there was a significant and clinically meaningful difference favoring the ginseng group. There were no discernible side effects during the course of the trial, either within or between groups.[34]

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