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Modafinil for attentional and psychomotor dysfunction in advanced cancer: a double-blind, randomised, cross-over trial

¹ Department of Palliative Care, Herning Hospital, Herning
² Unit of Acute Pain and Palliation, Rigshospitalet, Copenhagen

^* To whom correspondence should be addressed.

	Abstract

Cognitive impairment seems to be highly prevalent in patients with advanced cancer. Modafinil, a novel vigilance and wake-promoting agent, may be an alternative treatment. We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients. 28 cancer patients with a tiredness score of 50 mm or more on a scale of 0 to 10 (0 = no tiredness, 10 = worst possible tiredness) and Karnofsky Performance Status 40–70 were included. All medications were kept stable during the trial despite short acting opioids for breakthrough pain. On day 1 the patients were randomly assigned to receive 200 mg Modafinil orally or placebo and on day 4 they crossed-over to the alternative treatment. Finger Tapping Test (FTT), Trail Making Test (TMT) and Edmonton Symptom Assessment System (ESAS) were evaluated before tablet intake and again 4, 5 hours after. FTT for the dominant hand as well as TMT were statistically significantly improved on modafinil (p-values = 0.006 and 0.042, respectively). On ESAS, depression and drowsiness also improved statistically significantly (p-values = <0.001 and 0.038, respectively). Modafinil in a single dose regimen was significantly superior to placebo regarding two cognitive tests of psychomotor speed and attention. Furthermore subjective scores of depression and drowsiness were significantly improved by modafinil.

Key Words: cancer, cognition, modafinil, neuropsychological assessment and symptoms

First published on July 31, 2009
Palliative Medicine 2009, doi:10.1177/0269216309106872


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