Placebo Effect Beneficial in Treatment of Cancer-Related Fatigue

Open-label placebos may indeed have a positive effect on cancer-related fatigue in survivors, according to a recent study conducted by researchers at the University of Alabama at Birmingham (UAB) and Harvard Medical School.

Cancer-related fatigue is the most common side effect of cancer treatment, as reported by the American Cancer Society. Even years after treatment is over, many cancer survivors still struggle with fatigue that negatively impacts their mood, relationships and quality of life.

Unfortunately, current treatment options leave much to be desired, according to lead study author Teri Hoenemeyer, Ph.D., director of Education and Supportive Services at the UAB Comprehensive Cancer Center. “Treatments like Modafinal — which is one of the drugs most often prescribed for cancer-related fatigue – can have very negative side effects that often make the patient feel even worse.”

To combat the multi-dimensional problem that is cancer-related fatigue, Hoenemeyer and her colleagues looked to the placebo effect. “I was intrigued by the idea that placebos, even when study participants are told they are receiving placebos, can have a powerful effect on how people feel,” says Hoenemeyer.

To determine the effectiveness of open-label placebo treatment on cancer-related fatigue, a group of 74 cancer survivors who reported fatigue symptoms and completed cancer treatment six months to 10 years earlier were randomly assigned to receive either open-label placebo or treatment as usual.

Survivors in the placebo group took two pills — cellulose pills with no active ingredient – twice a day for 21 days. One key thing to remember, Hoenemeyer notes, is that honesty is key in placebo use. “Placebos are most effective when prescribed in an honest, supportive way that engages the patient,” she says. In this study, participants were told at every stage that these were inert pills with no pharmacological benefit, and given a full explanation of the placebo effect.

Nevertheless, according to the study, survivors who received the placebo reported a 29 percent improvement in fatigue severity and a 39 percent improvement in fatigue-disrupted quality of life.

After the initial 21 days, participants who received placebos discontinued use, while those in the treatment as usual group were offered to take the placebos for an additional three weeks.

While the new placebo recipients noted a significant improvement in fatigue, those who discontinued use did not experience a degradation of their improvement, leading researchers to conclude that the placebo effect has real benefits when treating cancer-related fatigue.

Why does it work? “There is so much that we just don’t know about the brain/body connection though much progress has been made in the field of placebo and pain research,” Hoenemeyer explains. “Current conventional wisdom is that underlying neurobiological mechanisms such as opioid and dopaminergic systems are responsible for the changes often seen with brain imaging when someone takes a placebo.” But the truth is the placebo effect is still largely a mystery.

Beyond fatigue treatment, this study may have implications for how the placebo effect can be used to cope with other cancer-related conditions. Future studies that will examine the treatment of pain, nausea, treatment-related hot flashes and neuropathy are currently being developed, says Hoenemeyer.

But she notes that to fully understand placebo effects, researchers must explore both physical and psycho-social factors as well. “It is critical that this type of research gets funded so that we can design better clinical trials and bring more drugs to market that are significantly more effective than placebos.”