Inflammation May Affect Depression, Activity, Regardless of Cancer

Inflammation may not be closely linked to cancer treatment-related symptoms, but can have an effect on quality of life, regardless of whether or not a person has a cancer diagnosis, according to recent research published in the journal, Cancers.

The team of researchers, led by an expert from Moffitt Cancer Center in Tampa, Florida, analyzed pro- and anti-inflammatory markers (substances found in the blood that affect inflammation) during and after (six and 12 months later, to be exact) chemotherapy in 121 patients with gynecologic cancer. Patients involved in the study could have the following diagnoses: ovarian, endometrial, peritoneal, fallopian, cervical, uterine or vaginal cancer.

The goal of the study was to determine if these markers influenced treatment-related symptoms, such as fatigue, depression, sleep and physical activity levels. Data, which was collected via blood samples and questionnaires, was compared against 105 study participants with no personal history of cancer.

“What makes our study unique is that it was a controlled comparison. Previous studies have evaluated treatment related symptoms in patients with different cancer types, but ours compared patient reported data with cancer free participant data,” Aasha Hoogland, lead study author and applied research scientist in the Health Outcomes and Behavior Department at Moffitt, said in a press release issued by Moffitt. “Specifically, we wanted to know if higher levels of inflammation were associated with worse treatment related symptoms.”

Study findings showed higher rates of fatigue, depression and sleep disturbances among patients with cancer compared to those without a diagnosis.

Fatigue rates were consistently higher in patients with a gynecologic cancer diagnosis.

Specifically, 60% of patients experienced clinically meaningful fatigue at the start of the study — a percentage which increased to 72% before the sixth chemotherapy cycle. At 12 months after completing chemotherapy, 55% of patients were experiencing meaningful fatigue. At these same time points, the percentages of individuals without cancer who were experiencing fatigue were 39%, 36% and 45%.

Depression rates were 23% at baseline, 26% before the sixth chemotherapy cycle and 18% a year after treatment for patients with cancer and ranged between 2% and 6% for the healthy population at any given time point, according to the study.

Sleep issues occurred in 80% of patients at the start of the study and stayed relatively unchanged (78%) before chemo cycle six, and then decreased to 61% 12 months after therapy ended. Sleep issues were stable in the non-cancer group, at 50%, 47% and 41%, respectively, across the three time points.

Additionally, physical activity in patients with gynecologic cancer tended to be lower but then improve over time.

While most inflammatory markers were not associated with an increase or decrease in treatment-related symptoms, the researchers did determine that a higher c-reactive protein — a protein produced in the liver that increases when there is inflammation in the body — was associated with greater depression and lower physical activity levels in both the cancer and non-cancer groups.

In the study, the authors explained a possible reason as to why inflammation could influence depression, stating, “inflammatory biomarkers are known to activate inflammatory processes in the brain, which, in turn, regulate neurotransmitters involved in mood and behavior, such as serotonin, norepinephrine and dopamine.”

Of note, serotonin is responsible for carrying messages between the nerve cells and the brain, and can contribute to a feeling of happiness or wellbeing, while norepinephrine is involved in the body’s “fight or flight” response and dopamine, another neurotransmitter, acts as the body’s “reward center,” and can play a role in bodily functions such as mood and movement, according to the Cleveland Clinic.
“While this finding was interesting, it suggests there may be other causal mechanisms of treatment related symptoms among gynecologic cancer patients beyond inflammation,” said Heather Jim,study author and co-leader of Moffitt’s Health Outcomes and Behavior Program, said in the release.

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