The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer

• Published in: PloS one Vol. 12; no. 5; p. e0177620
• Main Authors: Paulsen, Ørnulf, Laird, Barry, Aass, Nina, Lea, Tor, Fayers, Peter, Kaasa, Stein, Klepstad, Pål
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.05.2017; Public Library of Science (PLoS)
• Subjects: Aged; Analgesics; Analysis; Appetite - physiology; Biology and Life Sciences; Biomarkers; Biomarkers - metabolism; Cancer; Cancer therapies; Cancer treatment; Chronic fatigue syndrome; Clinical trials; Cognitive ability; Complications and side effects; Corticoids; Corticosteroid drugs; Corticosteroids; Cytokines; Cytokines - metabolism; Dosage and administration; Double-Blind Method; Erythrocyte sedimentation rate; Fatigue; Fatigue - metabolism; Fatigue - physiopathology; Female; Health aspects; Humans; IL-1β; Inflammation; Inflammation - metabolism; Inflammation - physiopathology; Inflammatory response; Interferon; Lung cancer; Male; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Multiple regression analysis; Narcotics; Neoplasms - metabolism; Neoplasms - physiopathology; Neurosciences; Oncology; Opioids; Pain; Pain - metabolism; Palliative care; Pancreatic cancer; Patients; Quality of Life; Randomized Controlled Trials as Topic - methods; Regression analysis; Risk factors; Rodents; Science; Surveys and Questionnaires; TNF inhibitors; Transforming growth factor-b1; Tumor necrosis factor-TNF; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177620

Systemic inflammation is associated with reduced quality of life and increased symptoms in patients with advanced cancer. The aims of this study were to examine the relationships between inflammatory biomarkers and the Patient Reported Outcome Measures (PROMs) of pain, appetite and fatigue; and to explore whether levels of baseline biomarkers were associated with changes in these PROMs following treatment with corticosteroids. An exploratory analysis was done on a trial examining the analgesic properties of corticosteroids in patients with advanced cancer. Inclusion criteria were: >18 years, taking opioids for moderate or severe cancer pain; pain ≥4 (numerical rating scale 0-10). Serum was extracted and levels of inflammatory biomarkers were assessed. PROMs of pain, appetite and fatigue were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The relationships between PROMs and inflammatory biomarkers were examined using Spearman Rho-Rank and multiple regression analysis. Data were available on 49 patients. Levels of sTNF-r1, IL-6, IL-18, MIF, MCP-1, TGF-β1, IL-1ra, and C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were elevated; IL-1β, IL-2, IL-4, IL-8, IL-10, IL-12(p70), interferon-γ, MIP-1α, and TNF-α were below the level of detection. The following correlations were observed: appetite and IL-6 and CRP; fatigue and IL-1ra (rs: 0.38-0.41, p< .01). There was no association between pretreatment biomarkers and effect from corticosteroid treatment. In patients with advanced cancer and pain, some pro-inflammatory cytokines were related to appetite and fatigue. Inflammatory biomarkers were not associated with pain or with the efficacy of corticosteroid therapy. Further research examining the attenuation of the systemic inflammatory response and possible effects on symptoms would be of interest.