The Systemic Inflammatory Response and Its Relationship to Pain and Other Symptoms in Advanced Cancer

Abstract

Introduction. Inflammation has been identified as a hallmark of cancer and may be necessary for tumorgenesis and maintenance of the cancer state. Inflammation-related symptoms are common in those with cancer; however, little is known about the relationship between symptoms and systemic inflammation in cancer. The aim of the present study was to examine the relationship between symptoms and systemic inflammation in a large cohort of patients with advanced cancer. Methods. Data from an international cohort of patients with advanced cancer were analyzed. Symptoms and patient-related outcomes were recorded using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core Questionnaire. Systemic inflammation was assessed using C-reactive protein levels. The relationship between these symptoms and systemic inflammation was examined using Spearman rank correlation (ρ) and the Mann-Whitney U test. Results. Data were available for 1,466 patients across eight European countries; 1,215 patients (83%) had metastatic disease at study entry. The median survival was 3.8 months (interquartile range [IQR] 1.3-12.2 months). The following were associated with increased levels of inflammation: performance status (p=.179), survival (p=.347), pain (p=.154), anorexia (p=.206), cognitive dysfunction (p=.137), dyspnea (p.150), fatigue (p=.197), physical dysfunction (p=.207), role dysfunction (p=.176), social dysfunction (p=.132), and poor quality of life (p=.178). All were statistically significant at p