Placebo as a Treatment Relieves Cancer-Related Fatigue

According to a first-of-its-kind study, as a treatment, placebo pills can relieve fatigue caused by cancer itself or its treatment.

What is a placebo?

A placebo is a medication containing no active ingredient that produces a suggestion-based effect . The Latin word means "to please." It can be given orally or by injection, like real medicines.

United States researchers conducted a single-center randomized study with 74 patients experiencing cancer pain, giving placebo pills twice daily as in routine treatment and comparing them with usual care.

Over 21 days, the placebo group (39 people) showed statistically significant improvements over controls (35 people) in fatigue severity and associated quality-of-life impairment.

Compared with controls, the placebo group reported 29% improvement in fatigue complaints and 39% improvement in fatigue-related quality-of-life reduction, a large effect.

All participants had at least moderate (clinically important) fatigue, with most (62%) having severe fatigue. All were post-treatment (6 months to 10 years). Most were women (74%) and white (69%).

This new placebo use differs from familiar use in clinical studies . Normally, researchers use concealed placebo, so participants do not know whether they receive a drug or placebo. Here, they were told it was placebo. This is the first open-label placebo studyin a cancer population with a chronic adverse condition.

Current widely accepted treatments for cancer fatigue are increased physical activity and psychosocial or mind-body interventions. Sleep patterns and insomnia should also be assessed. Modafinil is widely used and moderately effective, but studies did not find it significantly more effective than placebo, and it causes side effects such as sleep difficulty.

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Open-label placebo previously proved effective for irritable bowel syndrome, intermittent acute migraine attacks, chronic low back pain, allergic rhinitis and depression.

Researcher Hoenemeyer said clinicians should not be shocked by placebo as treatment, adding: "Many physicians use placebo-like treatments in practice, such as prescribing vitamins or antibiotics without checking laboratory results." Hoenemeyer says medical placebo use is ethical if physicians tell patients it is placebo.

Placebo's Power Remains Mysterious

Surprisingly, although we know about the placebo effect, we do not understand it. Researchers are still trying to establish how placebos work.

Patients expressing doubts were told their skepticism was understandable and encouraged to see what happened. After information was given, envelopes identified treatment groups. On day 11, cancer center staff checked all patients by telephone. After the 21-day study, they returned to complete fatigue questionnaires.

The authors say attentive clinical care may amplify placebo effects: "Much of the effect appears related to interaction with the person supporting the patient."

• How should patients, families and physicians communicate?

For 21 days after the main study, the other group was offered open-label placebo; of 35 participants, 34 tried it. They reported similar improvements in fatigue severity and quality-of-life impairment (23% and 35%, respectively).

These results are provocative, and it will be interesting to examine whether open-label placebo helps other chronic problems in cancer survivors, such as joint pain and abnormal sensations in hands and feet (neuropathy).

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