April 30, 2021
2 min read
Lee J, et al. C-reactive protein and fatigue among cancer survivors. Presented at: Oncology Nursing Society Congress (virtual meeting); April 20-29, 2021.
The authors report no relevant financial disclosures.
Interventions that target depressive symptoms and self-rated health conditions may reduce fatigue among cancer survivors, according to study results presented at the virtual Oncology Nursing Society Congress.
Incidence and severity of cancer-related fatigue vary greatly among individuals. Although the underlying mechanisms are not well-understood, prior research suggested chronic inflammation often contributes to this complex condition, according to study background.
C-reactive protein — an inflammatory marker — may be associated with fatigue.
Jungeun Lee, PhD, MSN, RN, assistant professor at University of Rhode Island College of Nursing, and colleagues aimed to evaluate associations between C-reactive protein and self-reported fatigue in a population-based sample of cancer survivors in the United States.
Researchers analyzed data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). This series of ongoing large-scale, nationally representative, cross-sectional surveys includes data obtained through physical examinations and interviews.
The cohort included 431 NHANES participants aged 20 years or older (mean age, 63.4 years; 57.8% men) with a self-reported diagnosis of cancer. The most common malignancies represented in the cohort included prostate cancer (16.7%), breast cancer (15.1%), nonmelanoma skin cancer (12.8%), melanoma (6.5%) and colon cancer (6.3%).
Blood samples obtained during study examinations yielded C-reactive protein measurements. A single item from the Patient Health Questionnaire-9 yielded self-reported fatigue measurements.
Investigators performed multiple logistic regression models to estimate associations between C-reactive protein and fatigue score. They adjusted these analyses for several variables, including sex, age, race and ethnicity, marital status, education, BMI, smoking status, pain and depression symptoms, physical activity, general health condition and sleep hours.
Slightly less than half of the cohort (46.5%; n = 200) reported fatigue, whereas 43.5% (n = 231) did not.
Researchers reported no significant difference between the fatigued and nonfatigued groups with regard to median age, (62.9 years vs. 63.8 years), sex (men, 63.7% vs. 52.4%), race/ethnicity (white, 82.6% vs. 84.5%), education (some college or higher, 64.9% vs. 73.6%) or BMI (mean, 30 kg/m2 vs. 29.5 kg/m2).
Survivors without fatigue were more likely than those with fatigue to report being in excellent or very good health (63.1% vs. 22.8%; P < .001).
Those who reported fatigue were more likely to be inactive (59.2% vs. 38.5%; P < .05) and be current smokers (37.8% vs. 18.2%; P < .01). They were more likely to report depressive symptoms (34.5% vs. 5.1%; P < .001) and pain (39.7% vs. 12.2%; P < .01), and they also were more likely to have higher C-reactive protein levels (3.47 mg/L vs. 2.69 mg/L; P < .05).
Multivariate adjusted analyses revealed a significant association between fatigue and overall poor health condition (OR = 5.45; 95% CI, 1.58-18.8) and depressive symptoms (OR = 1.38; 95% CI, 1.14-1.68).
“Higher C-reactive protein levels among survivors with fatigue warrant further longitudinal studies with a broad range of inflammatory markers and multidimensional measures of fatigue and other symptoms to better understand mechanisms,” Lee said during a presentation.