The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer

Abstract

The proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment.

High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study

“…[211] Co-occurring symptoms might trigger other symptoms negatively, impact negatively on functional performance, cognitive status, and QoL, [190] and interfere with daily life. [212] Symptom management in cancer patients is challenging, as the symptoms are most often influenced by one another and present in clusters. [99,190] Fatigue, has previously been found in an emotional cluster with depression.…”

Periodontal disease, sleep duration, and white blood cell markers in the 2009 to 2014 National Health and Nutrition Examination Surveys

“…A priori confounders for the hypothesized relationships were identified based on the existing literature 16,20,25,26,28,29,[31][32][33][34][35][36][37][38][39][40][41] and classified as sociodemographic, lifestyle, and healthrelated characteristics. Sociodemographic characteristics included age (in years; 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 96, and ≥70), race (Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black, and other), education (<high school, 9th to 11th grade, high school graduate/GED or equivalent, some college or AA degree, college graduate or higher), marital status (married/living with partner, other) and poverty income ratio (<100%, 100% to <200%, and ≥200%).…”

“…24 Similar to other inflammation-related chronic conditions, periodontal disease could be associated with a "sickness behavior" characterized by pain, fatigue, and sleep disturbance, depressed mood, loss of appetite, and cognitive dysfunction. 28 Recent studies have estimated that, since the mid-1970s, an increasing proportion of the worldwide population is reporting <7 hours of sleep. 23 Short sleep duration can have a negative impact on physical and mental health outcomes potentially through an immune-inflammatory mechanism, also pertaining to periodontitis.…”

C‐reactive protein, delirium, and other psychological symptoms among patients with advanced cancer

“…2 A randomized trial reported that a low skeletal muscle mass (sarcopenia) due to cachexia was associated with depression and quality of life in patients with advanced cancer. 16 Other studies on cancer patients revealed that systemic inflammation or elevated CRP levels were related to pain, anorexia, dyspnoea, fatigue, sleep disturbance, activities of daily living disabilities, and survival, [8][9][10][11][12][13][14][15] that these symptoms rarely existed in isolation, 11,13,39 and that pain, fatigue, and sleep disturbance were the basis of a symptom cluster in combination with reduced physical function. 14 A cross-sectional study showed a higher physical and psychological symptom burden (including pain, fatigue, sleep disturbance, distress, and anxiety) in patients with cancer cachexia, which increased with the stages of cachexia, and these findings emphasized the importance of screening for multiple co-occurring symptoms in cachexia patients.…”

“…sleep disturbance, depression, and cognitive dysfunction, as well as physical disorders in patients with cancer. [7][8][9][10][11][12][13][14][15][16] Nevertheless, studies on CNS regulation in cancer cachexia have been limited to investigations on the systemic levels of neuromodulatory peptides, such as appetite-regulating hormones. 2 Moreover, 'sickness behaviour' has been reported in infected mammals and recognized as a symptom cluster, including fatigue, sleep disturbance, depression, and cognitive dysfunction, which is associated with systemic inflammation and its impact on the CNS.…”