Dexamethasone 8?mg for Cancer-Related Fatigue in Inpatients with Advanced Cancer Undergoing Palliative Care: A Multicenter Phase II Trial

Abstract

Objective: No standard treatment for cancer-related fatigue (CRF) for inpatients in a palliative care setting exists. The aim of this study was to validate the previous study-derived efficacy of dexamethasone 8?mg for CRF among inpatients in a palliative care setting. Methods: Inpatients with moderate fatigue (?4/10) were enrolled in a multicenter phase II trial. Dexamethasone 8?mg p.o. or 6.6?mg i.v. was administered for seven days and 4?mg p.o. or 3.3?mg i.v. for seven consecutive days. The primary endpoint was a threshold average change of Functional Assessment of Chronic Illness Therapy (FACIT)-fatigue subscale score of 3. The secondary endpoints were evaluated with the anorexia-cachexia subscale (ACS), and the Edmonton symptom assessment scale-revised Japanese version. Results: A total of 32 patients were enrolled. On day 8, the mean change of FACIT-fatigue subscale from day 1 was 5.2 (95% confidence interval 0.8?10.0), in which the lower bound was above 0 but not above the prespecified threshold value of 3.0 (p?=?0.72). Edmonton symptom assessment system (ESAS)-fatigue was significantly improved by day 3 (p?=?0.02), but not on day 8 or day 15. ACS, physical well-being, and ESAS-lack of appetite significantly improved by day 8 and day 15. Adverse events were tolerable. Conclusion: This study showed that dexamethasone 8?mg failed to achieve the preset efficacy for CRF among inpatients in a palliative care setting. However, this treatment improved fatigue and would be an option for CRF. jRCT (jRCTs031180068).

Keywords

• appetite
• cancer patients
• cancer-related fatigue
• dexamethasone
• inpatient
• palliative care