Longitudinal associations between inflammatory markers and fatigue up to two years after colorectal cancer treatment

Nadira R Querido, Marlou Floor Kenkhuis, Eline H van Roekel, Stéphanie O Breukink, Fränzel J B van Duijnhoven, Maryska Lg Janssen-Heijnen, Eric T P Keulen, Per Magne Ueland, F Jeroen Vogelaar, Evertine Wesselink, Martijn Jl Bours, Matty P Weijenberg*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Fatigue is often reported by colorectal cancer survivors (CRC) and largely impacts their quality of life. Inflammation has been linked to fatigue mainly in breast cancer patients. Therefore, we investigated how inflammation is longitudinally associated with fatigue in CRC survivors, up to 2 years post-treatment.

METHODS: A total of 257 patients from the ongoing Energy for life after ColoRectal cancer (EnCoRe) cohort study were included in the analysis. Plasma levels of IL6, IL8, IL10, TNFα, hsCRP, and fatigue were measured at 6 weeks, 6, 12, and 24 months post-treatment. Fatigue was measured through the validated Checklist Individual Strength (CIS total, 20-140), consisting of four subscales - subjective fatigue (8-56), motivation (4-28), physical activity (3-21), and concentration (5-35), and the EORTC QLQ-C30 fatigue subscale (0-100). Linear mixed-models were used to assess the confounder-adjusted longitudinal associations between inflammatory markers and overall fatigue along with the subscales.

RESULTS: Mean levels of CIS fatigue decreased from 62.9 at 6 weeks to 53.0 at 24 months. In general, levels of inflammatory markers also decreased over time. No statistically significant longitudinal associations were found between IL6, IL8, IL10, TNFα, and fatigue. Higher levels of hsCRP were associated with more CIS fatigue (β per SD 3.21, 95% CI 1.42; 5.01) and EORTC fatigue (β 2.41, 95% CI 0.72; 4.10).

CONCLUSION: Increased levels of hsCRP are longitudinally associated with more post-treatment fatigue in CRC survivors.

IMPACT: These findings suggest that low-grade inflammation may play a role in fatigue reported by CRC survivors up to 2 years post-treatment.

Original languageEnglish
Pages (from-to)1638-1649
Number of pages12
JournalCancer Epidemiology Biomarkers & Prevention
Volume31
Issue number8
Early online date2 Jun 2022
DOIs
Publication statusPublished - Aug 2022

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