Hi Betty-

Besides having your thyroid checked, which everyone who had radiation for HNC should do (regularly), you may wish to ask your doctor about trying l-carnitine supplementation.

There is a growing body of evidence that l-carnitine deficiency is not uncommon in cancer patients, especially in those who have received cisplatin (and probably also carboplatin) therapy. This amino acid derivative is critical to fatty acid metabolism.

Some recent studies (google "l-carnitine and cancer fatigue") have shown significant benefits and no side effects for moderate l-carnitine supplementation. Several ongoing NCI clinical trials are now assessing this in a larger patient population (see below).

With his doctors' OK, my husband took 500 mg l-carnitine in his later treatment stages and in the month following end of treatment. and he never experienced serious fatigue. Another Hopkins patient (who reported severe fatigue similar to that of Betty) decided to try it as well and she said she regained normal activity within a short time. These are just two "anecdotal data points" (that is, there may have been other reasons for the loss of fatigue) but clinical studies have also shown similar results in controlled environments.

L-carnitine is often touted by sports enthusiasts as an "energy booster" but there is little or no scientific evidence to support this in a healthly individual with normal carnitine levels. However, the story for cancer patients appears to be different.

Here is description of one NCI trial:

Carnitine Supplementation for Cancer-Related Fatigue

Name of the Trial
Phase III Randomized Study of Levocarnitine (L-carnitine) for the Management of Fatigue in Cancer Patients (ECOG-4Z02). See the protocol summary at http://cancer.gov/clinicaltrials/ECOG-E4Z02.

Principal Investigators
Drs. Ricardo Cruciani and Russell Portenoy of the Eastern Cooperative Oncology Group

Why Is This Trial Important?
Fatigue is one of the most common side effects of cancer and cancer treatment. For many people with cancer, fatigue may become a critical issue in their lives, affecting their ability to work, to socialize, to relate to family and friends, and to maintain a healthy lifestyle. Despite its prevalence, however, there is no standard of care for the treatment of fatigue in cancer patients.

Low levels of the nutrient carnitine may contribute to feelings of fatigue in cancer patients. Carnitine plays an important role in cellular energy production by helping in the metabolism of fatty acids, which represent a major fuel source for tissues such as the heart and skeletal muscle. Levocarnitine (L-carnitine) is a nutritional supplement that may help alleviate fatigue by increasing the level of carnitine in the body. In this trial, researchers will assess the prevalence of carnitine deficiencies in cancer patients and examine the effect of carnitine supplementation in patients experiencing moderate to severe fatigue. Patients will be randomly assigned to receive levocarnitine or a placebo.

"Fatigue is a major complaint of many cancer patients, but it is one of the least studied complications of cancer and cancer treatment," said Dr. Cruciani. "With this trial, we hope to learn better how to improve the quality of life and well being of cancer patients."