- Question from Chat: After having a stem cell transplant in September 1999 I still am very fatigued. Everything is an effort. What can I do to help my limitations?
- Answers —Russell Portenoy, M.D.: The question points out that some women can develop very prolonged fatigue after treatment ends. This phenomenon is not well recognized by the medical community, but certainly occurs. The management is as we've said before. A person should undergo a good evaluation, including measurement of hemoglobin and other chemicals in the blood. Assessment of nutrition, sleep, mood, and general conditioning And based on this information, try to develop a strategy to minimize the factors that may be contributing to fatigue. If reversal of the contributing causes does not help a person with a serious degree of fatigue some physicians are now using strategies like drug therapy. Drugs such as the psycho stimulants and a few others can be tried in selected patients to try to reverse fatigue. The stimulants include drugs like methylphenidate or Ritalin, or dextroamphetamine or Dexadrine, or Modafinal or Provigil.
- Marisa Weiss, M.D., president and founder: How do you determine who can benefit from these medications?
- Russell Portenoy, M.D.: At this point we don't know who is going to respond well and who is going to develop side effects. We don't know much about which drug is better, what's the best dose, how long the benefit will last. But there is enough experience to suspect that the person who is fatigued and who has no medical contra versant to the use of a stimulant, might benefit from a trial.
- Lillian Nail, Ph.D., R.N.: Would it be fair to say that this is a research topic that was just gaining in popularity?
- Russell Portenoy, M.D.: This is an area that certainly needs more clinical investigation. Although some doctors are trying to use these medications based on good clinical judgment and their experience, we really have very little evidence of ethicality and safety.
- Marisa Weiss, M.D., president and founder: What about caffeine--the good old cup of coffee? Does it help at all?
- Russell Portenoy, M.D.: Caffeine is another stimulant that some people do use. Physicians rarely prescribe something that you can buy in the supermarket, but there is no reason to believe that caffeine cannot be as effectively used as any of the other psycho stimulants.
- Lillian Nail, Ph.D., R.N.: We don't have much information about long-term fatigue right now and the work on the psycho stimulants really reflects an interest in looking at the problem rather than a full answer to the question.
On Wednesday, March 21, 2001, our Ask-the-Expert Online Conference was called Ease Fatigue, Boost Energy. Lillian Nail, Ph.D., R.N., Russel Portenoy, M.D., and Marisa Weiss, M.D. answered your questions about ways to manage fatigue and increase energy levels.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Lillian Nail, Ph.D., R.N., is the Dr. May Rawlinson Distinguished Professor and a senior scientist at the Oregon Health Sciences University School of Nursing in Portland.
Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.
