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

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Summary

Background. 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.

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References

  • GA Curt W Breitbart D Cella JE Groopman SJ Horning LM Itri et al. (2001) Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition M Marty S Pecorelli (Eds) Fatigue and Cancer, vol 5 1st ed. Elsevier Amsterdam 3–16

    Google Scholar 

  • P Stone M Richards J Hardy (1998) ArticleTitleFatigue in patients with cancer Eur J Cancer 34 1670–1676 Occurrence Handle10.1016/S0959-8049(98)00167-1 Occurrence Handle1:STN:280:DyaK1M7gvFGhug%3D%3D Occurrence Handle9893650

    Article  CAS  PubMed  Google Scholar 

  • P Stone A Richardson E Ream AG Smith DJ Kerr N Kearney (2000) ArticleTitleCancer-related fatigue: inevitable, unimportant and untreatable Results of a multi-centre patient survey. Cancer Fatigue Forum Ann Oncol 11 971–975 Occurrence Handle11038033 Occurrence Handle10.1023/A:1008318932641 Occurrence Handle1:STN:280:DC%2BD3cvoslOktw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • A Atkinson A Barsevick D Cella B Cimprich C Cleeland A Donner et al. (2000) ArticleTitleNCCN Practice Guidelines for Cancer-Related Fatigue Oncology (Huntingt) 14 151–161

    Google Scholar 

  • N de Jong AM Courtens HH Abu-Saad HC Schouten (2002) ArticleTitle Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature Cancer Nurs 25 283–297 Occurrence Handle12181497 Occurrence Handle10.1097/00002820-200208000-00004

    Article  PubMed  Google Scholar 

  • MK Chen (1986) ArticleTitleThe epidemiology of self-perceived fatigue among adults Prev Med 15 74–81 Occurrence Handle3714661 Occurrence Handle10.1016/0091-7435(86)90037-X Occurrence Handle1:STN:280:BimB3szhsFQ%3D

    Article  PubMed  CAS  Google Scholar 

  • BF Piper (1992) Subjective fatigue in women receiving six cycles of adjuvant chemotherapy for breast cancer. Doctoral Dissertation. San Francisco University of California

    Google Scholar 

  • A IOP AM Manfredi S Bonura (2004) ArticleTitleFatigue in cancer patients receiving chemotherapy: an analysis of published studies Annals of Oncology 15 712–720 Occurrence Handle15111337 Occurrence Handle10.1093/annonc/mdh102 Occurrence Handle1:STN:280:DC%2BD2c3htFyntQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • MR Visser EM Smets (1998) ArticleTitleFatigue, depression and quality of life in cancer patients: how are they related Support Care Cancer 6 101–118 Occurrence Handle10.1007/s005200050142 Occurrence Handle9540167 Occurrence Handle1:STN:280:DyaK1c3gtV2qsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • JA Broeckel PB Jacobsen J Horton L Balducci GH Lyman (1998) ArticleTitleCharacteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer J Clin Oncol 16 1689–1696 Occurrence Handle9586880 Occurrence Handle1:STN:280:DyaK1c3ks1aqsA%3D%3D

    PubMed  CAS  Google Scholar 

  • GR Morrow PL Andrews JT Hickok JA Roscoe S Matteson (2002) ArticleTitleFatigue associated with cancer and its treatment Support Care Cancer 10 389–398 Occurrence Handle10.1007/s005200100293 Occurrence Handle12136222

    Article  PubMed  Google Scholar 

  • Morrow GR., Shelke AR, Roscoe JA, Hickok JT: Management of cancer-related fatigue. Cancer Investigat 2004.

  • JE Bower PA Ganz KA Desmond JH Rowland BE Meyerowitz TR Belin (2000) ArticleTitleFatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life J Clin Oncol 18 743–753 Occurrence Handle10673515 Occurrence Handle1:STN:280:DC%2BD3c7jvFCkug%3D%3D

    PubMed  CAS  Google Scholar 

  • NS Tchekmedyian J Kallich A McDermott PM Fayers MH Erder (2003) ArticleTitleThe relationship between psychologic distress and cancer-related fatigue Cancer 98 198–203 Occurrence Handle12833472 Occurrence Handle10.1002/cncr.11463

    Article  PubMed  Google Scholar 

  • KS Blesch JA Paice R Wickham N Harte DK Schnoor S Purl et al. (1991) ArticleTitleCorrelates of fatigue in people with breast or lung cancer Oncol Nurs Forum 18 81–78 Occurrence Handle2003120 Occurrence Handle1:STN:280:By6C28visVY%3D

    PubMed  CAS  Google Scholar 

  • SC Jamar (1989) Fatigue in women receiving chemotherapy for ovarian cancer S Funk E Tournquist M Champagne L Copp R Weise (Eds) Key Aspects of Comfort: Management of Pain, Fatigue and Nausea Springer New York 224–228

    Google Scholar 

  • BF Piper AM Lindsey MJ Dodd S Ferketich SM Paul S Weller (1989) The development of an instrument to measure the subjective dimension of fatigue SG Funk EM Tornquist MT Champagne LA Copp RA Wiess (Eds) Key Aspects of Comfort: Management of Pain, Fatigue, and Nausea Springer New York 199

    Google Scholar 

  • Andrews PLR, Morrow GR: Approaches to understanding the mechanisms involved in fatigue associated with cancer and its treatments: a speculative review. In: Marty M, Pecorelli S (eds) Fatigue and Cancer. Elsevier Science B.V., 2001.

  • S Wessely M Hotopf MC Sharpe (1999) Chronic Fatigue and its Syndromes Oxford University Press New York

    Google Scholar 

  • DL Murphy I Campelli JL Costa (1978) Current status of the indoleamine hypothesis of the affective disorders MA Lipton A DiMasco KF Killam (Eds) Psychopharmacology: A Generation of Progress Raven Press New York 1235–1247

    Google Scholar 

  • DL Tollefson JF Rosenbaum (1998) Selective serotonin reuptake inhibitors AF Schatzberg CB Nemeroff (Eds) Textbook of Psychopharmacolory 2nd ed. American Psychiatric Press Washington DC 219–237

    Google Scholar 

  • J Bearn S Wessely (1994) ArticleTitleNeurobiological aspects of the chronic fatigue syndrome Eur J Clin Inv 24 79–90 Occurrence Handle10.1111/j.1365-2362.1994.tb00971.x Occurrence Handle1:STN:280:ByuB28rotVw%3D

    Article  CAS  Google Scholar 

  • GR Morrow JT Hickok JA Roscoe RF Raubertas PL Andrews PJ Flynn et al. (2003) ArticleTitleDifferential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program J Clin Oncol 21 4635–4641 Occurrence Handle10.1200/JCO.2003.04.070 Occurrence Handle14673053 Occurrence Handle1:CAS:528:DC%2BD2cXpsVWqurc%3D

    Article  PubMed  CAS  Google Scholar 

  • Pugh LC: Psychophysiological correlates of fatigue during childbirth. Doctoral Dissertation. University of Maryland, 1990.

  • B Tack (1991) Dimensions and correlates of fatigue in older adults with rheumatoid arthritis. Doctoral Dissertation University of California San Francisco

    Google Scholar 

  • DM McNair M Lorr LF Droppelman (1971) Manual for the Profile of Mood States. Educational and Industrial Testing Service San Diego

    Google Scholar 

  • H Yoshitake (1978) ArticleTitleThree characteristic patterns of subjective fatigue symptoms Ergonomics 21 231–233 Occurrence Handle27351 Occurrence Handle10.1080/00140137808931718 Occurrence Handle1:STN:280:CSeB3MvlvVY%3D

    Article  PubMed  CAS  Google Scholar 

  • PM Meek LM Nail A Barsevick AL Schwartz S Stephen K Whitmer et al. (2000) ArticleTitlePsychometric testing of fatigue instruments for use with cancer patients Nurs Res 49 181–190 Occurrence Handle10929689 Occurrence Handle10.1097/00006199-200007000-00001 Occurrence Handle1:STN:280:DC%2BD3czpvVCksg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  • S Shacham (1983) ArticleTitleA shortened version of the Profile of Mood States J Pers Assess 47 305–306 Occurrence Handle6886962 Occurrence Handle10.1207/s15327752jpa4703_14 Occurrence Handle1:STN:280:BiyB1MzpvFQ%3D

    Article  PubMed  CAS  Google Scholar 

  • LS Radloff (1977) ArticleTitleThe CES-D scale: a self-report depressive scale for research in the general population J Appl Psychol Measur 1 385–401 Occurrence Handle10.1177/014662167700100306

    Article  Google Scholar 

  • CF Caley SS Weber (1993) ArticleTitleParoxetine: a selective serotonin reuptake inhibiting antidepressant [Review] Ann Pharmacother 27 1212–1222 Occurrence Handle8251692 Occurrence Handle1:CAS:528:DyaK2cXksVyqug%3D%3D

    PubMed  CAS  Google Scholar 

  • RL Spitzer et al. (1995) Diagnostic and Statistical Manual of Mental Disorders (Revised). 4th ed. American Psychiatric Association Washington DC

    Google Scholar 

  • SS Hwang VT Chang M Rue B Kasimis (2003) ArticleTitleMultidimensional independent predictors of cancer-related fatigue J Pain Symptom Manage 26 604–614 Occurrence Handle12850643 Occurrence Handle10.1016/S0885-3924(03)00218-5

    Article  PubMed  Google Scholar 

  • JE Bower PA Ganz N Aziz JL Fahey (2002) ArticleTitleFatigue and proinflammatory cytokine activity in breast cancer survivors Psychosom Med 64 604–611 Occurrence Handle12140350

    PubMed  Google Scholar 

  • KW Kelley RM Bluthe R Dantzer JH Zhou WH Shen RW Johnson et al. (2003) ArticleTitleCytokine-induced sickness behavior Brain, Behavior Immun 17 IssueIDSuppl 1 S112–S118 Occurrence Handle10.1016/S0889-1591(02)00077-6 Occurrence Handle1:CAS:528:DC%2BD3sXhsVCgsL0%3D

    Article  CAS  Google Scholar 

  • AJ Parker S Wessely AJ Cleare (2001) ArticleTitleThe neuroendocrinology of chronic fatigue syndrome and fibromyalgia Psychol Med 31 1331–1345 Occurrence Handle11722149 Occurrence Handle1:STN:280:DC%2BD3MnnsFyktA%3D%3D

    PubMed  CAS  Google Scholar 

  • S Ancoli-Israel PJ Moore (2001) ArticleTitleThe relationship between fatigue and sleep in cancer patients: A review Eur J Cancer Care (Engl) 10 245–255 Occurrence Handle10.1046/j.1365-2354.2001.00263.x Occurrence Handle1:STN:280:DC%2BD38%2FotVWguw%3D%3D

    Article  CAS  Google Scholar 

  • JA Roscoe GR Morrow JT Hickok P Bushunow S Matteson D Rakita et al. (2002) ArticleTitleTemporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment Support Care Cancer 10 329–336 Occurrence Handle12029433 Occurrence Handle10.1007/s00520-001-0317-0

    Article  PubMed  Google Scholar 

  • RK Portenoy LM Itri (1999) ArticleTitleCancer-related fatigue: guidelines for evaluation and management Oncologist 4 1–10 Occurrence Handle10337366 Occurrence Handle1:STN:280:DyaK1M3mvFKlsg%3D%3D

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Rochester Cancer Center, 601 Elmwood Avenue, Box 704, Rochester, New York, 14642, USA

    Joseph A. Roscoe, Gary R. Morrow, Jane T. Hickok, Karen M. Mustian, Jennifer J. Griggs & Sara E. Matteson

  2. Rochester General Hospital Cancer Center, Rochester

    Peter Bushunow

  3. Highland Hospital Cancer Center, Rochester, NY, USA

    Raman Qazi & Brian Smith

Authors
  1. Joseph A. Roscoe
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  2. Gary R. Morrow
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  3. Jane T. Hickok
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  4. Karen M. Mustian
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  6. Sara E. Matteson
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  7. Peter Bushunow
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  8. Raman Qazi
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  9. Brian Smith
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Correspondence to Joseph A. Roscoe.

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Roscoe, J.A., Morrow, G.R., Hickok, J.T. et al. Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat 89, 243–249 (2005). https://doi.org/10.1007/s10549-004-2175-1

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