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Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo- controlled trial in patients with advanced cancer.

Yennurajalingam S, Frisbee-Hume S, Palmer JL et al.
J Clin Oncol 2013; 25: 3076-3082

Summary: 

This prospective study contains the first randomised test of the efficacy of dexamethasone (4 mg 2x daily over 14 days). The main inclusion criterion was the presence of ≥ 3 symptoms within the previous 24 hours (e.g. pain, fatigue, chronic nausea, disturbed sleep, depression or loss of appetite). In the Edmonton Symptom Assessment, the minimum value had to be ≥ 4 (on a scale of 0 – 10). Eighty-four (84) of 132 randomised patients could be evaluated. On day 15, the results of the FACIT-F subscale were significantly better in the dexamethasone arm than in the placebo arm (9 [± 10.3] versus 3.1 [± 9.59]; p = 0.008). There were no significant differences in the adverse events. The authors concluded that dexamethasone is more active than placebo in the treatment of fatigue in patients with advanced cancer.

Editor’s Comments: Dr. Karin Jordan

This is the first large randomised study on the efficacy of dexamethasone in fatigue. As already described in many case reports and small series, this provides an evidence-based proof of efficacy. The side effects in this study were not significantly different, although it must be emphasised that the period of observation was only 14 days, so that long-term toxicity cannot be assessed. Thus, dexamethasone is generally a good short term therapeutic option for the treatment of fatigue in patients with advanced cancer.

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