Psychostimulants for cancer-related cognitive impairment in adult cancer survivors: a systematic review and meta-analysis

• Published in: Supportive care in cancer Vol. 27; no. 10; pp. 3717 - 3727
• Main Authors: Miladi, Nadia, Dossa, Richi, Dogba, Maman Joyce, Cléophat-Jolicoeur, Marie Immacula Fabienne, Gagnon, Bruno
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2019; Springer; Springer Nature B.V
• Subjects: Adult; Adults; Brain tumors; Cancer; Cancer survivors; Cancer Survivors - psychology; Cancer therapies; Care and treatment; Central Nervous System Stimulants - therapeutic use; Cognition - drug effects; Cognitive ability; Cognitive Dysfunction - drug therapy; Evidence-based medicine; Humans; Medicine; Medicine & Public Health; Meta-analysis; Methylphenidate - therapeutic use; Modafinil - therapeutic use; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Pain Medicine; Palliative care; Psychotropic drugs; Quality of Life - psychology; Randomized Controlled Trials as Topic; Rehabilitation Medicine; Review Article; Side effects; Survivor; Systematic review; Survivorship; Cancer; Cognitive impairment; Psychostimulants
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-04907-w

Background
Cognitive impairment is recognized as a common symptom experienced by cancer survivors which impacts on quality of life (QoL) and day-to-day activities. One of the treatment options is the use of psychostimulants but the evidence supporting its use remains unclear.
Objectives
To identify the level of evidence of psychostimulants’ effect on the management of cognitive impairment in adult cancer survivors.
Methods
Electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL) and reference lists of relevant reviews were searched from inception to December 2017, with no language restrictions applied. Randomized controlled trials (RCTs), evaluating the effect of psychostimulants on cognitive impairment among cancer patients with no primary or secondary brain tumor or brain radiation, were included. The primary outcome was cognitive function changes, whereas secondary outcomes were adverse events (AEs) and QoL.
Results
Six RCTs were included: three studies investigating methylphenidate and three modafinil, with a total of 244 and 146 patients, respectively. Due to important differences in methodologies between studies, a meta-analysis was assumed inappropriate for the primary outcome. A narrative synthesis was performed. One study using methylphenidate and two using modafinil demonstrated improvements in some cognitive functions as measured by objective cognitive assessment tests. Psychostimulants did not improve QoL and were not associated with more AEs.
Conclusion
To date, limited evidence is available to estimate the usefulness (or lack) of psychostimulants on cognitive function in this population.