Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study

Abstract

Background and purpose Mechanisms of fatigue reported during radiotherapy are poorly defined but may include inflammatory cytokines and/or sleep disturbances. This prospective, longitudinal, phase II study assessed fatigue, sleep, and serum cytokine levels during radiotherapy for early-stage prostate cancer (PCa). Material and methods Twenty-eight men undergoing radiotherapy for early-stage PCa wore an Actiwatch Score to record fatigue level, sleep time, onset latency, efficiency and wake after sleep onset. Serum levels of IL-1α, IL-1β, TNF-α, IL-6, IL-8, IL-10 and VEGF were measured weekly during radiotherapy. Patient reported quality of life (QOL) metrics were collected before and after treatment. Linear mixed effects models examined trajectories across treatment weeks. Results Fatigue increased across treatment weeks (P < .01), and fatigue was associated with decreased patient-reported QOL. Sleep efficiency increased across treatment weeks (rate of change over time = .29, P = .03), and sleep onset latency decreased (rate of change over time = .86, P = .06). IL-6 tended to increase during treatment (P = 0.09), but none of the cytokine levels or sleep variables were significantly related to fatigue trajectories. Conclusions Despite increased sleep efficiency across treatment weeks, fatigue significantly increased. Although IL-6 increased during the course of radiotherapy, cytokines levels were not associated with fatigue scores or sleep disturbance. Further studies are needed to define the mechanisms for fatigue during radiotherapy.

Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer

“…In a previous study of men with fatigue 1 year after RT completion for prostate cancer, fatigue was not associated with age, body mass index (BMI), ADT use, hemoglobin level, or gastrointestinal integrity [8]. Demographic (age and gender) and social factors (marital status, income) have been associated with chronic fatigue [2, 4, 13]; however, the results can be inconsistent [16-18]. There has been no study that simultaneously explored all these factors to understand their association with RT-related persistent fatigue occurrence.…”

Inflammation‐ and angiogenesis‐related biomarkers are correlated with cancer‐related fatigue in colorectal cancer patients: Results from the ColoCare Study

“…There are prior data on inflammatory biomarkers as risk factors for cancer‐related fatigue in a variety of cancer types such as breast, prostate cancer and, to a limited degree, colorectal cancer (Doong et al, ; Holliday et al, ; Rodrigues, Trufelli, Fonseca, Paula, & Giglio, ; Starkweather et al, ; Vardy et al, ; Xiao et al, ). With respect to colorectal cancer, a prior study ( n = 80) examined the association between biomarker levels including IL‐6 or TGF‐α and fatigue in metastatic colorectal cancer patients (Rich et al, ).…”

The Etiology and management of radiotherapy-induced fatigue

“…RIF is one of the debilitating symptoms most often reported by cancer patients receiving RT, often negatively impacting their HRQoL [5,14,15]. As a subtype of cancer treatment-related fatigue, RIF is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living and is not relieved by rest or sleep [4,5,8].…”

“…As a subtype of cancer treatment-related fatigue, RIF is described as a pervasive, subjective sense of tiredness persisting over time, interferes with activities of daily living and is not relieved by rest or sleep [4,5,8]. RIF often leads to depression, impaired cognitive function, sleep disturbance, decreased physical activity, and decreased HRQoL [14,16,17]. The prevalence and severity of fatigue is slightly different in cancer patients receiving varying treatments [18].…”

“…The prevalence and severity of fatigue is slightly different in cancer patients receiving varying treatments [18]. RIF has been noted to increase slightly beginning at week 3 of treatment, then worsen significantly in severity by week 6 of RT, remaining elevated following the completion of treatment [14,19–21]. RIF is a distressing and highly prevalent symptom experienced by cancer patients during RT.…”