Longitudinal associations of plasma metabolites with persistent fatigue among colorectal cancer survivors up to 2 years after treatment

Roekel, Eline H. van; Bours, Martijn J.L.; Breukink, Stéphanie O.; Aquarius, Michèl; Keulen, Eric T.P.; Gicquiau, Audrey; Rinaldi, Sabina; Víneis, Paolo; Arts, Ilja C. W.; Gunter, Marc J.; Leitzmann, Michael F.; Scalbert, Augustin; Weijenberg, Matty P.

doi:10.1002/ijc.34252

Cited by 9 publications

(6 citation statements)

References 57 publications

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“…It is possible that this type of multimodal approach could be responsible for the observed reduction in fatigue because physical activity and cognitive behavioral therapy interventions have been shown to effectively reduce fatigue in CRC patients [ 42 , 43 , 44 ]. However, it is just as possible that the same fatigue improvement could have been observed without in-patient rehabilitation because some studies showed that fatigue levels could reduce after treatment, even without any intervention or medication, possibly due to the gradual reduction in inflammation caused by treatment [ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation—First Results of the MIRANDA Study

Vlaški

Slavić

Caspari

et al. 2023

Cancers

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Cancer-related fatigue, low quality of life (QoL), and low ability to work are highly prevalent among colorectal cancer (CRC) patients after tumor surgery. We aimed to analyze their intercorrelations and trajectories in the first year after in-patient rehabilitation in the German multicenter MIRANDA cohort study. Recruitment is ongoing, and we included the first 147 CRC patients in this analysis. Participants filled out questionnaires at the beginning of in-patient rehabilitation (baseline) and at 3, 6, 9, and 12 months after the baseline. The EORTC-QLQ-C30-General-Health-Status (GHS)/QoL, the FACIT-F-Fatigue Scale, and the FACIT-F-FWB-ability-to-work items were used to evaluate QoL, fatigue, and ability to work, respectively. The fatigue and QoL scales were highly correlated (r = 0.606). A moderate correlation was observed between the fatigue and ability to work scales (r = 0.487) and between the QoL and ability to work scales (r = 0.455). Compared to the baseline, a statistically significant improvement in the QoL, ability to work, and fatigue scales were observed at the 3-month follow-up (Wilcoxson signed rank test, all p < 0.0001). The three scales plateaued afterward until the 12-month follow-up. In conclusion, fatigue, QoL, and ability to work were highly interrelated, improved quickly during/after in-patient rehabilitation, and did not change much afterward in German CRC patients.

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Section: Discussionmentioning

confidence: 99%

Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation—First Results of the MIRANDA Study

Vlaški

Slavić

Caspari

et al. 2023

Cancers

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“…The scale consists of 22 numeric rating scales, assessing fatigue across four subdomains: behavioral (6 items), affective (5 items), sensory (5 items), and cognitive (6 items). Fatigue severity is described using a 10-point numeric scale: mild (1, 2), moderate (3)(4)(5), and severe (6)(7)(8)(9). Assessments were made before treatment (baseline, T0), after 1 week of treatment (T1), after 2 weeks of treatment (T2), after 3 weeks of treatment (end of treatment, T3), and after 6 weeks of treatment (end of follow-up, T4).…”

Section: Outcome Measuresmentioning

confidence: 99%

“…The incidence of CRF during cancer treatment has been reported to range from 25% to 99%, with moderate to severe CRF occurring in 30% to 60% of cases (1). In colorectal cancer survivors, more than one-third continue to suffer from CRF for a year or longer after the end of cancer treatment (3). At present, there are no universally accepted and effective pharmacological treatments for CRF.…”

Section: Introductionmentioning

confidence: 99%

Governor vessel moxibustion for cancer-related fatigue in colorectal patients: a randomized trial

Huang

et al. 2023

Front. Oncol.

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ObjectiveThis study aimed to investigate the efficacy and mechanism of action of Governor Vessel Moxibustion (GVM) in the treatment of Cancer-Related Fatigue (CRF) in patients who have completed treatment for colorectal cancer.MethodsWe randomly assigned 80 CRF patients in a 1:1 ratio to either the experimental group or the control group. During the three-week treatment period, both groups of patients received usual care for CRF provided by professional nurses. The experimental group received additional GVM treatment (three times a week, nine times total). The primary outcome was the mean change in total fatigue score from baseline to the end of treatment, assessed using the Chinese version of the Piper Fatigue Scale.ResultsAt baseline, the total fatigue scores were 6.20 ± 0.12 in the experimental group and 6.16 ± 0.14 in the control group. At the end of treatment, the total fatigue scores decreased by 2.03 points (32.7% decrease from baseline) in the experimental group and by 0.99 points (15.6% decrease from baseline) in the control group. The absolute reduction in total fatigue scores in the experimental group was 1.04 points higher than in the control group (95% CI, 0.93 to 1.15; P<0.001), corresponding to a relative difference of 17.1% (95% CI, 15.2% to 18.9%; P<0.001). At the end of treatment, the experimental group showed greater reductions in interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels compared to the control group. No serious adverse events related to GVM treatment were observed.ConclusionGVM appears to be safe and effective for alleviating CRF in patients who have completed colorectal cancer treatment, which may be related to the modulation of IL-6 and TNF-α levels.Trial registrationChinese Clinical Trials Registry: ChiCTR2300069208.

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“…18 This review concluded that decreased circulating levels of Trp and a higher kynurenine-to-tryptophan ratio (KTR) were cross-sectionally associated with more fatigue and worse HRQoL among patients with lymphoma, 19 lung cancer, 20 and patients with various types of cancer, including gastrointestinal tumors, hematological malignancy, gynecological neoplasm, and lung cancer. 21 Only limited studies have investigated the involvement of Trp and/or Kyn in cancer-related fatigue and HRQoL specifically in CRC, 22,23 and reported that higher Trp concentrations were associated with less fatigue.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal associations of plasma kynurenines and ratios with fatigue and quality of life in colorectal cancer survivors up to 12 months post‐treatment

Holthuijsen,

van Roekel,

Bours

et al. 2024

Intl Journal of Cancer

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Fatigue is prevalent in colorectal cancer (CRC) survivors, impacting their health‐related quality of life (HRQoL). Inflammation‐induced activation of the kynurenine pathway may play a role in cancer‐related fatigue and HRQoL, but evidence is scarce. Therefore, we aimed to investigate longitudinal associations of plasma tryptophan, kynurenines, and ratios with fatigue and HRQoL in CRC survivors up to 12 months post‐treatment. Repeated measurements at 6 weeks, 6 months, and 12 months post‐treatment were performed in 249 stage I‐III CRC survivors. Plasma tryptophan and eight kynurenines were analyzed using liquid chromatography‐tandem mass spectrometry (LC/MS–MS). Fatigue and HRQoL outcomes were evaluated using validated questionnaires. Confounder‐adjusted linear mixed models were conducted to analyze longitudinal associations, with false discovery rate (FDR) correction. Higher tryptophan (Trp), kynurenic acid (KA), and xanthurenic acid (XA) concentrations, as well as a higher kynurenic acid‐to‐quinolinic acid ratio (KA/QA), were associated with less fatigue and better functioning, while a higher kynurenine‐to‐tryptophan ratio (KTR) and 3‐hydroxykynurenine ratio (HKr) were associated with more fatigue and worse functioning. Finally, higher KA and XA concentrations and a higher KA/QA ratio were associated with a higher overall HRQoL summary score, while a higher HKr was associated with a lower overall HRQoL summary score. In conclusion, we observed that tryptophan and several kynurenines were longitudinally associated with fatigue and HRQoL in CRC survivors up to 12 months post‐treatment. Future research is needed to validate our findings and explore the potential of the kynurenine pathway as intervention target for reducing fatigue and enhancing HRQoL after CRC treatment.

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Longitudinal associations of plasma metabolites with persistent fatigue among colorectal cancer survivors up to 2 years after treatment

Cited by 9 publications

References 57 publications

Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation—First Results of the MIRANDA Study

Development Trajectories of Fatigue, Quality of Life, and the Ability to Work among Colorectal Cancer Patients in the First Year after Rehabilitation—First Results of the MIRANDA Study

Governor vessel moxibustion for cancer-related fatigue in colorectal patients: a randomized trial

Longitudinal associations of plasma kynurenines and ratios with fatigue and quality of life in colorectal cancer survivors up to 12 months post‐treatment

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