Associations between the gut microbiome and fatigue in cancer patients

Abstract

Fatigue is the most prevalent symptom of cancer and its treatments. Changes in the intestinal microbiome have been identified in chronic fatigue syndrome and other neuropsychiatric disorders, and cancer patients. However, the association between intestinal microbiome and fatigue in patients with advanced cancers has not been evaluated. Understanding the connection between intestinal microbiome and fatigue will provide interventional and therapeutic opportunities to manipulate the microbiome to improve fatigue and other patients’ reported outcomes. In this project, we aimed to identify associations between microbiome composition and fatigue in advanced cancer patients. In this cross-sectional observational study at a tertiary cancer care center, we included 88 patients with advanced, metastatic, unresectable cancers who were in a washout period from chemotherapy. We measured fatigue using the MD Anderson Symptom Inventory—Immunotherapy fatigue score, and used 16srRNA to analyze intestinal microbiome. Using correlation analysis we found that Eubacterium hallii was negatively associated with fatigue severity scores (r = − 0.30, p = 0.005), whereas Cosenzaea was positively associated with fatigue scores (r = 0.33, p = 0.0002). We identified microbial species that exhibit distinct composition between high-fatigued and low-fatigued cancer patients. Further studies are warranted to investigate whether modulating the microbiome reduces cancer patients’ fatigue severity and improves their quality of life.

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“…Possible ways to gain such insights would involve analyzing stored serum or plasma samples collected from large registration trials for changes in cytokines and correlation with patient-reported fatigue. Recently gut microbiome has been associated with fatigue [9] and it will be interesting to explore its role in ICIrelated fatigue. There is also a need to investigate various approaches to help mitigate the burden of fatigue including cytokine antagonists, other pharmacotherapies such as methylphenidate, and interventions such as cognitivebehavioral therapies, mind-body therapies, and supervised exercise programs [6,7].…”

Trait Energy and Fatigue May Be Connected to Gut Bacteria among Young Physically Active Adults: An Exploratory Study

“…Recently, several studies reported an association between gut microbiome and feelings of fatigue [ 38 , 39 , 40 , 41 ]; however, these studies did not distinguish between the mental and physical aspects of fatigue. These preliminary findings have reported reduced diversity and altered gut microbiome among patients with cancer-related fatigue [ 38 , 40 ] and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [ 39 , 41 ].…”

“…Recently, several studies reported an association between gut microbiome and feelings of fatigue [ 38 , 39 , 40 , 41 ]; however, these studies did not distinguish between the mental and physical aspects of fatigue. These preliminary findings have reported reduced diversity and altered gut microbiome among patients with cancer-related fatigue [ 38 , 40 ] and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [ 39 , 41 ]. These studies were exploratory in nature, with some studies not adjusting analyses to account for multiple comparisons [ 38 , 40 , 41 ] and others comparing ME/CFS patients to healthy control populations [ 39 , 41 ].…”

“…These preliminary findings have reported reduced diversity and altered gut microbiome among patients with cancer-related fatigue [ 38 , 40 ] and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) [ 39 , 41 ]. These studies were exploratory in nature, with some studies not adjusting analyses to account for multiple comparisons [ 38 , 40 , 41 ] and others comparing ME/CFS patients to healthy control populations [ 39 , 41 ]. One limitation of these recent studies is that findings have cannot be extrapolated to healthy populations.…”

“…One limitation of these recent studies is that findings have cannot be extrapolated to healthy populations. Another limitation is that previous studies [ 38 , 39 , 40 , 41 ] have measured fatigue as a lack of energy rather than measuring energy and fatigue as two separate unipolar moods with their own unique mental and physical components. Taken together, these limitations suggest there is a need to examine the association between gut microbiome diversity and feelings of mental and physical energy and fatigue uniquely among healthy individuals.…”