Implication for decision-makers

Methylphenidate does not currently have a licence for the management of cancer-related fatigue, although individual practitioners may take responsibility for prescribing medication beyond the licenced indications. The PCF42 currently describes a limited role for prescribing MPH in palliative care populations beyond license, in situations where fatigue is refractory to other measures. However, in the light of the results of our study, clinicians should be discouraged from doing so. Local and professional guidelines should amend their recommendations accordingly. Palliative medicine higher specialist training programmes should discourage practitioners from using MPH for the relief of fatigue in palliative care patients with advanced cancer. Although there have been conflicting results from previous studies, the balance of evidence describes that MPH, although generally safe, is ineffective for this indication.