Sara Matteson

Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy

SummaryBackground. Fatigue can significantly interfere with a cancer patient’s ability to fulfill daily responsibilities and enjoy life. It commonly co-exists with depression in patients undergoing chemotherapy, suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue. Methods. We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy randomly assigned to receive either 20 mg of the selective serotonin re-uptake inhibitor (SSRI) paroxetine (Paxil®, SmithKline Beecham Pharmaceuticals) or an identical-appearing placebo. Patients began their study medication seven days following their first on-study treatment and continued until seven days following their fourth on-study treatment. Seven days after each treatment, participants completed questionnaires measuring fatigue (Multidimensional Assessment of Fatigue, Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist) and depression (Profile of Mood States-Depression subscale [POMS-DD] and Center for Epidemiologic Studies-Depression [CES-D]). Results. Repeated-measures ANOVAs, after controlling for baseline measures, showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D (p=0.006) and the POMS-DD (p=0.07) but not in reducing fatigue (all measures, ps > 0.27). Conclusions. Although depression was significantly reduced in the 44 patients receiving paroxetine compared to the 50 patients receiving placebo, indicating that a biologically active dose was used, no significant differences between groups on any of the measures of fatigued were observed. Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment.

Nausea and emesis: evidence for a biobehavioral perspective

Abstract For most people, nausea and vomiting (NV) are simply unfortunate consequences of overindulgent college days or overenthusiastic amusement rides. Yet for most cancer patients, nausea and vomiting (also referred to as emesis) remain among the most frequent side effects of cancer chemotherapy. Patients typically view control of nausea as more important than control of emesis, while physicians and nurses judge emesis control to be more important to antiemetic efficacy than nausea control. The 5-HT3 receptor antagonists have been shown to be clinically more effective in controlling emesis, particularly that caused by regimens containing high-dose cisplatin, than previously available agents. Disappointingly, however, these drugs do not appear to be more effective than previous antiemetics in reducing nausea. In addition, the 5-HT3 receptor antagonists may become less effective over repeated chemotherapy administrations, and they remain expensive. An impediment to research progress has been an insularity that has prompted two parallel research efforts: one searching for biological understanding to enhance pharmacological intervention(s) and the other searching for psychological understanding to aid in developing more effective behavioral intervention(s). While both approaches have been successful, it is time to have the two views merge into a biobehavioral framework that combines them both. This paper draws on both physiological and psychological origins of NV to begin the development of a biobehavioral model of development that integrates features of both approaches.

Treatment of Radiotherapy-Induced Fatigue Through a Nonpharmacological Approach

Background: Cancer-related fatigue (CRF) is a frequently occurring, burdensome side effect of radiation therapy that can result in detrimental effects to health-related quality of life (HRQL). The findings from a pilot study examining the efficacy of the complementary and alternative practice of Polarity Therapy (PT) in reducing CRF and improving HRQL are reported.Methods: Fifteen women undergoing radiation therapy for breast cancer and experiencing fatigue were randomized to receive 1, 2, or no PT treatments. Treatments were given 1 week apart to the patients receiving 2 treatments. Fatigue and HRQL were assessed at baseline prior to PT, 3 days following the first PT treatment (week 1), and 3 days following the second PT treatment (week 2). Results: There was a statistically significant improvement in both CRF and HRQL in the 10 patients who received a PT treatment compared to the 5 control patients at the week 1 assessment. In addition, there was a statistically significant difference among the 3 treatment groups in improvement in CRF at the week 2 assessment. This finding, coupled with a visual inspection of the means, supports the plausibility of a dose response concerning PT.Conclusion: Results from this pilot investigation suggest that PT may have a positive influence on CRF and HRQL in women undergoing radiation treatment for breast cancer. Randomized, controlled clinical trials with larger sample sizes are needed.