TY - JOUR
T1 - Associations Among Hypogonadism, C-Reactive Protein, Symptom Burden, and Survival in Male Cancer Patients with Cachexia
T2 - A Preliminary Report
AU - Del Fabbro, Egidio
AU - Hui, David
AU - Nooruddin, Zohra I.
AU - Dalal, Shalini
AU - Dev, Rony
AU - Freer, Gina
AU - Roberts, Lynn
AU - Palmer, J. Lynn
AU - Bruera, Eduardo
N1 - Funding Information:
This work was supported, in part, by the American Cancer Society grant PEP-08-299-01-PC1 (E.D.F.), the National Institutes of Health grants RO1NR010162-01A1 , RO1CA122292-01 , and RO1CA124481-01 (E.B.), and the Clinician Investigator Program, Royal College of Physicians and Surgeons of Canada (D.H.).
PY - 2010/6
Y1 - 2010/6
N2 - Context: Cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival. Objectives: To explore the relationships among these factors, a retrospective study of male cancer patients was conducted. Methods: The charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. Results: Median CRP was 20 mg/L, and median testosterone level was 185 ng/dL (6.42 nmol/L) (normal ≥240 ng/dL or 8.36 nmol/L). There was an inverse correlation between testosterone and CRP levels (P < 0.01). Lower testosterone was associated with increased dyspnea and insomnia (P < 0.05). Poor appetite and insomnia (P < 0.05) correlated with elevated CRP. Survival of patients with testosterone levels ≤185 ng/dL (6.42 nmol/L) was decreased compared with that of those with levels >185 ng/dL (13 vs. 62 weeks, P = 0.004). Patients with CRP levels >10 mg/L had decreased survival compared with those with levels ≤10 mg/L (15 vs. 46 weeks, P = 0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia. Conclusion: Our preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.
AB - Context: Cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival. Objectives: To explore the relationships among these factors, a retrospective study of male cancer patients was conducted. Methods: The charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. Results: Median CRP was 20 mg/L, and median testosterone level was 185 ng/dL (6.42 nmol/L) (normal ≥240 ng/dL or 8.36 nmol/L). There was an inverse correlation between testosterone and CRP levels (P < 0.01). Lower testosterone was associated with increased dyspnea and insomnia (P < 0.05). Poor appetite and insomnia (P < 0.05) correlated with elevated CRP. Survival of patients with testosterone levels ≤185 ng/dL (6.42 nmol/L) was decreased compared with that of those with levels >185 ng/dL (13 vs. 62 weeks, P = 0.004). Patients with CRP levels >10 mg/L had decreased survival compared with those with levels ≤10 mg/L (15 vs. 46 weeks, P = 0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia. Conclusion: Our preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.
KW - Cachexia
KW - hypogonadism
KW - inflammatory marker
KW - survival
KW - symptoms
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U2 - 10.1016/j.jpainsymman.2009.09.021
DO - 10.1016/j.jpainsymman.2009.09.021
M3 - Article
C2 - 20457506
AN - SCOPUS:77953122018
SN - 0885-3924
VL - 39
SP - 1016
EP - 1024
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -