ABSTRACT
Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35-79) years, 5 females, were followed for median 5.5 (1-12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI < 20 kg/m(2) and weight loss >2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p < 0.001) than the non-cachectic patients. They also had a slightly, but insignificantly longer survival than non-cachectic patients (p = 0.08). The mGPS should be considered as an additional framework for identification of cancer cachexia.
Subject(s)
Biomarkers, Tumor/metabolism , Cachexia/metabolism , Pancreatic Neoplasms/metabolism , Adenocarcinoma/blood , Adenocarcinoma/metabolism , Adenocarcinoma/pathology , Adipokines/blood , Adipokines/metabolism , Adult , Aged , Biomarkers, Tumor/blood , Cachexia/blood , Cachexia/pathology , Case-Control Studies , Cytokines/blood , Cytokines/metabolism , Energy Intake , Female , Humans , Inflammation/blood , Inflammation/metabolism , Inflammation/pathology , Longitudinal Studies , Male , Middle Aged , Neoplasm Staging , Pancreatic Neoplasms/blood , Pancreatic Neoplasms/pathology , Pilot Projects , Prospective StudiesABSTRACT
PURPOSE: Cancer cachexia and low energy intake (EI) probably contribute to weight loss in advanced pancreatic cancer (PC). However, little is known about the actual EI in this disease. Aims were to assess EI, weight loss and symptoms during the disease course and investigate associations between symptoms and EI. METHODS: Thirty-nine patients (21 males) with advanced PC were consecutively included and followed every 4 weeks until the end of life. A 24-h dietary recall was used to assess EI. The Edmonton Symptom Assessment System (ESAS) and the PC-specific health-related quality of life questionnaire (QLQ-PAN26) were used for symptom assessment. RESULTS: Median age was 62 years (48-88), WHO performance status 1 (0-2) and survival 5 months (1-25). Seventeen (44 %) patients had unresectable cancer, 16 (41 %) metastatic and six (15 %) recurrent disease. Upon inclusion, 37 (95 %) reported weight loss (median 4.0 kg per month). During follow-up, median weight loss per month was <1.0 kg. Forty to 65 % had EI <29 kcal/kg/day (cut-off value for weight maintenance) during the observation period but they did not lose more weight than patients with EI ≥ 29 kcal. Strong negative correlations (r range) were found between EI and pain (0.51-0.61), fatigue (0.54-0.67), oral dryness (0.61-0.64) and loss of appetite (0.53-0.71). CONCLUSION: In this study, several symptoms influenced EI negatively. Low EI did not completely explain weight loss in this patient group, but careful monitoring and early follow-up of symptoms may be important interventions to reduce weight loss in advanced PC.
