Placebo Reduces Fatigue in Cancer Survivors

Cancer-related fatigue is a debilitating adverse effect that can disrupt a patient’s life and have a lasting impact even after the end of treatment. Effective treatments to alleviate fatigue could result in unwanted conditions, such as psychosis, panic, or heart failure.

Placebo pills may be an effective method for cancer survivors who are struggling to manage fatigue according to a study published by Nature Scientific Reports. Patients even noticed relief when they were made aware the treatment was a placebo, the study found.

Patients were explicitly told the pill was a placebo and had a clear understanding when enrolling in the study. Researchers found that the patients’ opinion of the placebo effect did not affect whether they experienced improved fatigue.

"Some people who thought the placebo wouldn't do anything had a good response; others who believed it would help didn't have a response," said lead author Teri Hoenemeyer, PhD. "Fooling or deceiving patients may be unnecessary for placebo effects to produce benefits, with automatic neurological processes being a possible mechanism for the effects. This has revolutionary implications for how we might exploit the power of placebo effects in clinical practice."

The pills were made of cellulose and contained no active ingredients, according to the authors.

The study included 74 survivors of different types of cancer who experienced moderate-to-severe fatigue. Patients were randomized to receive placebo or the standard therapy for fatigue.

Patients randomized to receive the placebo were aware of the inactive treatment and were instructed to take 2 pills twice daily for 3 weeks.

After the initial 3 weeks, patients who received the usual treatment were given the option to switch to the placebo. Those who originally took the placebo discontinued treatment.

Patients knowingly taking the placebo experienced a significant improvement in fatigue and those who discontinued the placebo maintained their improvement, according to the study.

"Participants still had benefits three weeks after they stopped taking the placebo pills, which hasn't been shown before," said co-author Kevin Fontaine, PhD. "The extension of benefits even when the placebo pills are discontinued has been a surprise finding that has many placebo researchers excited."

Patients taking placebos reported a 29% reduction in fatigue severity and a 39% improvement in overall quality of life measures related to fatigue, according to the study.

The authors noted that open-label placebo pills have been shown to relieve symptoms in patients with irritable bowel syndrome, chronic low-back pain, and migraine headaches. These results suggest the treatment approach may also improve fatigue among cancer survivors.

"Cancer survivors report that fatigue is their most distressing symptom, even more distressing than other symptoms like nausea or pain, and clinicians struggle to find ways to help them with it," Dr Hoenemeyer said. "The effects of the placebo pills on fatigue were so dramatic that we had a number of the study patients ask if they could be given more placebo pills. For ethical reasons, we were unable to do so."