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

Publication: Paulsen Ø, Laird B, Aass N, Lea T, Fayers P, Kaasa S, et al. (2017) The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer. PLoS ONE 12(5): e0177620. https://doi.org/10.1371/journal.pone.0177620

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Abstract

Background

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.

Material
and Methods

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.

Results

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.

Conclusion

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.