Fatigue is associated with inflammation in patients with head and neck cancer before and after intensity-modulated radiation therapy

Xiao, Canhua; Beitler, Jonathan J.; Higgins, Kristin; Conneely, Karen N.; Dwivedi, Bhakti; Felger, Jennifer C.; Wommack, Evanthia C.; Shin, Dong M.; Saba, Nabil F.; Ong, Luke Yeeloo; Kowalski, Jeanne; Bruner, Deborah Watkins; Miller, Andrew H.

doi:10.1016/j.bbi.2015.10.016

Cited by 74 publications

(102 citation statements)

References 61 publications

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“…For example, numerous studies have described altered levels of circulating inflammatory markers as a contributor to fatigue in cancer therapy [30,34–40]. Our group has previously prospectively correlated changes in HNC patients' inflammatory markers to MFI-20 scores [41]. Additionally, chemotherapy has been implicated as a likely contributor; patients undergoing RT for breast cancer, for example, have been demonstrated to experience worse fatigue if they had previously undergone chemotherapy [42–44].…”

Section: Discussionmentioning

confidence: 99%

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Ferris

Zhong

Switchenko

et al. 2018

Radiotherapy and Oncology

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Background and purpose Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. Materials and methods At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. Results Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p < 0.05). Each 1 Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.026), and 0.25 (p = 0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1 Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.027), and 0.25 (p = 0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. Conclusions In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.

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Section: Discussionmentioning

confidence: 99%

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Ferris

Zhong

Switchenko

et al. 2018

Radiotherapy and Oncology

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“…69,70 Although the etiology of RT-related fatigue is unknown, data support an association between pro-inflammatory cytokines including TNF-α, IL-1β, and IL-6 activity and post-treatment fatigue in breast, prostate, and head and neck cancer. 71–74 These pro-inflammatory cytokines are of particular interest in older adults with LA-HNSCC as they have also demonstrated an association with disease and disability, 75 and serum levels of these biomarkers and their associated symptoms decrease with exercise in older adults. 76,77 …”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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“…During cancer treatment, the increase in circulating concentrations of inflammatory markers, such as C-reactive protein (CRP) and interleukin (IL-6), was related to the development of an overall feeling of fatigue (53–55). Inflammation has also been associated with higher levels of post-cancer persistent fatigue.…”

Section: Inflammation and Fatiguementioning

confidence: 99%

Role of Inflammation in Human Fatigue: Relevance of Multidimensional Assessments and Potential Neuronal Mechanisms

2017

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Fatigue is a highly disabling symptom in various medical conditions. While inflammation has been suggested as a potential contributor to the development of fatigue, underlying mechanisms remain poorly understood. In this review, we propose that a better assessment of central fatigue, taking into account its multidimensional features, could help elucidate the role and mechanisms of inflammation in fatigue development. A description of the features of central fatigue is provided, and the current evidence describing the association between inflammation and fatigue in various medical conditions is reviewed. Additionally, the effect of inflammation on specific neuronal processes that may be involved in distinct fatigue dimensions is described. We suggest that the multidimensional aspects of fatigue should be assessed in future studies of inflammation-induced fatigue and that this would benefit the development of effective therapeutic interventions.

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Fatigue is associated with inflammation in patients with head and neck cancer before and after intensity-modulated radiation therapy

Cited by 74 publications

References 61 publications

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Role of Inflammation in Human Fatigue: Relevance of Multidimensional Assessments and Potential Neuronal Mechanisms

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