Psychostimulant use for cancer-related fatigue in an oncology palliative care clinic: a retrospective cohort study

Abstract Purpose Psychostimulants are prescribed for cancer-related fatigue (CRF), although data on real-world use are scant and trials have shown mixed results. We aimed to describe the prevalence and predictors of psychostimulant use in an oncology palliative care clinic (OPCC). Methods This retrospective cohort study included new patients seen in the OPCC at the Princess Margaret Cancer Centre, Toronto, Canada from 2022/6/4-2025/7/24, excluding those with prior psychostimulant use. We recorded demographic and clinical characteristics, including performance status, symptom scores, and outpatient psychostimulant prescriptions following the initial OPCC visit. We calculated the prevalence of subsequent psychostimulant prescription and evaluated factors associated with psychostimulant prescription using univariable and multivariable logistic regression. For psychostimulant recipients, we evaluated adherence and reported effects. Results Of 3,587 patients (age 66.5 ± 14.3 years, 49% female) with advanced solid tumours (92.0%) and hematologic malignancies (8.0%), 75.3% reported at least moderate (≥ 4/10) fatigue. Following the initial clinic visit, 193 (5.4%) received psychostimulant prescriptions; of these, 183 (94.8%) received methylphenidate. On multivariable analysis, psychostimulant receipt was associated with worse fatigue (OR 1.16, 95%CI 1.07–1.26), breast cancer diagnosis (OR 2.58, 95%CI 1.28–5.20 vs. thorax), and younger age (OR 0.97, 95%CI 0.96–0.99). Among 77 evaluable patients who received a psychostimulant from the OPCC and adhered to treatment (all received methylphenidate), CRF improved in 53 (68.8%); 3 (3.9%) reported non-serious adverse events. Conclusion Despite a high prevalence of CRF in outpatients receiving palliative care, few patients were treated with psychostimulants. Further research is needed to evaluate the efficacy of psychostimulants and understand prescribing practices.