Leslie Blackhall, MD
Palliative care clinical cancer research
Dr. Blackhall is the Director of the Palliative Care Research Program. The mission of the Palliative Care service at the University of Virginia is to improve the quality of life for patients with cancer and other life threatening illnesses. The research program of this service is dedicated to clinical research projects which enhance the evidence base regarding management of symptoms commonly faced by cancer patients, such as pain, fatigue, nausea and vomiting, anxiety and depression.
The Palliative Care service was a participant in a multi-site study of methylnaltrexone, a novel agent for the reversal of opiod-induced constipation. This study, recently completed, has confirmed the efficacy and safety of this agent for this serious and often dose limiting side effect of narcotic pain medications. Currently Palliative Care is conducting an investigator initiated trial of modafinal for cancer related fatigue. Fatigue is the most frequently reported symptom experienced by cancer patients. Often, cancer-related fatigue is the symptom that is most distressing and causes the greatest interference with activities of daily life, with some patients being totally disabled by this common side effect of cancer and cancer treatment. Unfortunately, fatigue is not routinely assessed in this patient population and therefore it often goes untreated. The belief that fatigue is an inevitable side effect of cancer that patients must endure has increasingly come into question, as new tools for assessing fatigue have revealed its high incidence and severe impact in cancer patients, and as new agents for treating fatigue have become available. One new agent that may hold great promise in treating fatigue in cancer patients is modafinil. Modafinil is a wakefulness-promoting agent that is FDA-approved for the treatment of excessive daytime sleepiness associated with narcolepsy. Positive results have also been reported in clinical trials evaluating the safety and efficacy of modafinil in improving fatigue associated with multiple sclerosis and depression. To date, no studies have been performed evaluating the safety and efficacy of modafinil in cancer patients. Along with safety data, this pilot study will provide preliminary data regarding the efficacy of modafinil in improving fatigue and other neurobehavioral symptoms (e.g. depression, cognitive dysfunction) commonly observed in cancer patients. The Cancer Center's Clinical Trials Office was critical to the opening and conduct of the supportive care trials.