Associations Among Hypogonadism, C-Reactive Protein, Symptom Burden, and Survival in Male Cancer Patients with Cachexia: A Preliminary Report

• Published in: Journal of pain and symptom management 2010-06, Vol.39 (6), p.1016-1024
• Main Authors: Del Fabbro, Egidio, MD, Hui, David, MD, Nooruddin, Zohra I., MD, Dalal, Shalini, MD, Dev, Rony, MD, Freer, Gina, RN, Roberts, Lynn, RN, Palmer, J. Lynn, PhD, Bruera, Eduardo, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Appetite loss; Biological and medical sciences; C-Reactive Protein - metabolism; Cachexia; Cachexia - complications; Cachexia - mortality; Cancer; Cost of Illness; Humans; hypogonadism; Hypogonadism - blood; Hypogonadism - complications; inflammatory marker; Insomnia; Kaplan-Meier Estimate; Male; Medical sciences; Men; Middle Aged; Neoplasms - complications; Neoplasms - mortality; Pain Medicine; Pharmacology. Drug treatments; Retrospective Studies; Survival; Survival Analysis; Symptoms; Testosterone; Testosterone - blood; Treatment Outcome; Young Adult
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2009.09.021

Abstract Context Cachexia is characterized by muscle wasting, anorexia, and elevated inflammatory markers. In patients without cancer, hypogonadism is associated with lower lean body mass, increased symptom burden, and decreased survival. Hypogonadism in cancer cachexia could exacerbate symptoms, facilitate a proinflammatory state, and decrease survival. Objectives To explore the relationships among these factors, a retrospective study of male cancer patients was conducted. Methods The charts of 98 consecutive male patients referred to a cachexia clinic at a comprehensive cancer center were reviewed. All patients reported weight loss of >5% within the preceding six months; the median age was 60 years. Fifty-seven (58%) had serum C-reactive protein (CRP), and 68 (69%) had total testosterone evaluated. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. Results Median CRP was 20 mg/L, and median testosterone level was 185 ng/dL (6.42 nmol/L) (normal ≥240 ng/dL or 8.36 nmol/L). There was an inverse correlation between testosterone and CRP levels ( P < 0.01). Lower testosterone was associated with increased dyspnea and insomnia ( P < 0.05). Poor appetite and insomnia ( P < 0.05) correlated with elevated CRP. Survival of patients with testosterone levels ≤185 ng/dL (6.42 nmol/L) was decreased compared with that of those with levels >185 ng/dL (13 vs. 62 weeks, P = 0.004). Patients with CRP levels >10 mg/L had decreased survival compared with those with levels ≤10 mg/L (15 vs. 46 weeks, P = 0.01). The combination of hypogonadism and elevated CRP was associated with poorer prognosis. Elevated CRP levels were associated with increased symptom burden and decreased survival. Low testosterone was associated with decreased survival and correlated inversely with CRP levels, dyspnea, and insomnia. Conclusion Our preliminary results suggest that testosterone and CRP may be additive or synergistic as markers for survival in male patients and could be useful in future prognostic models.