Patient Controlled Methylphenidate for Cancer Related Fatigue: A Double Blind, Randomized, Placebo Controlled Trial

Inclusion Criteria: * Presence of fatigue on a numerical scale during the last 24 hours of more or equal to 4 on a 0 to 10 scale in which 0 equals no fatigue and 10 worst possible fatigue. * Patients should describe fatigue as being present for a minimum of four days. * If patients are on opioids for the treatment of cancer pain, change of opioids is allowed. * No clinical evidence of cognitive failure, with normal Mini Mental State Examination (MMSE). A score of 24 is considered as normal. * Sign written informed consent. * Patients must be 18 years or older. * Patient willing to keep a daily diary, engage in daily telephone follow up with a nurse, and after 7 days of treatment patient will return for a follow up visit. * Patient must have telephone access to be contacted daily by the research nurse. * Hemoglobin of \>/=10 g/dl within 2 weeks of enrollment. If the patient has not had blood drawn for a hemoglobin level in the past two weeks, one will be done to determine the eligibility. Exclusion Criteria: * Major contraindication to methylphenidate i.e. hypersensitivity, anxiety, tension, agitation, or motor tics * Currently on methylphenidate or has been on methylphenidate within the last 10 days. * Inability to complete the baseline assessment forms or to understand the recommendations for participation in the study. * Pregnant or lactating women. * Patients taking MAO inhibitors, tricyclic antidepressants and clonidine. * Patients with glaucoma, history of marked anxiety disorder, or history of substance abuse. * CAGE questionnaire score for the last 2 years is 2 or above on a 0 to 4 scale * History of Tourette's syndrome * Patients with tachycardia and uncontrolled hypertension.