Abstract
Systemic inflammation and disease progression are proposed causes of cancer-related fatigue. We aimed to investigate longitudinal changes in fatigue burden according to disease progression, systemic inflammation and therapy type. We prospectively collected validated questionnaires on fatigue (EORTC QLQ-C30, QLQ-FA12) and parameters of systemic inflammation (CRP, interleukin 6, procalcitonin) in patients with solid tumors undergoing palliative systemic cancer therapy. Baseline measurements were performed at start of a new therapy and follow-up measurements at the subsequent re-staging. The median follow-up time was 2 months (range 1-4 months). 79 patients (39/79 (49.4%) females; 40/79 (50.6%) males) with diagnosis of metastatic lung cancer (15/79; 19%), colorectal cancer (15/79; 19%), pancreatic cancer (11/79; 13.9%), sarcoma (11/79; 13.9%), breast cancer (7/79; 8.9%) or other cancers (20/79; 25.3%) were included. 35/79 (44.3%) of patients were treated with chemotherapy (CHT), 17/79 (21.5%) with immune checkpoint inhibitors (ICIs), 8/79 (10.1%) with combinational CHT-ICI, 6/79 (7.6%) with targeted therapies and 13/79 (16.5%) with combinational CHT-targeted therapy. Patients receiving ICI showed a significant reduction in the QLQ-FA12 Interference with daily life symptom scale (p=0.031) while a rising QLQ-FA12 Physical fatigue symptom scale was evident in patients receiving CHT (p=0.046). Levels of procalcitonin rised significantly in patients receiving CHT (p=0.04) while decreased in patients receiving targeted therapy (p=0.026). Patients with a progressive disease showed a significant increase in the QLQ-C30-FA symptom scale (p= 0.013), QLQ-FA12 Physical fatigue symptom scale (p=0.005) and QLQ-FA12 Interference with daily life symptom scale (p=0.022). No association between disease control and type of applied therapy or fatigue level and systemic inflammation was observed. A significant change of fatigue scales and procalcitonin level according to treatment type and disease control could be shown in our prospective patient cohort. Further longitudinal investigation is warranted to investigate the association of systemic inflammation and fatigue burden in different treatment types.
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