Higher levels of fatigue are associated with higher CRP levels in disease-free breast cancer survivors.

OBJECTIVE: To investigate the associations between level of fatigue and various potential inflammatory biomarkers for fatigue after multivariate adjustments for possible confounders in a sample of 299 disease-free survivors of breast cancer (BCSs) at a mean of 4 years post diagnosis. METHODS: Medical record data were used for cancer-related information, and a follow-up mailed survey collected data on fatigue, depression, anxiety and insomnia symptoms as well as information on demographics, physical health, medication and lifestyle. Blood samples drawn at an outpatient examination were analyzed for leukocyte count, high sensitivity C-reactive Protein (CRP), interleukin 1 receptor antagonist (IL-1ra), interleukin-6 (IL-6), soluble tumor necrosis factor receptor type 1 (sTNF-R1) and neopterin. RESULTS: Fatigue levels were significantly and positively associated with hsCRP (p<.001) and leukocyte count (p=.018), but not with levels of IL-1ra, IL-6, sTNF-R1 or neopterin in unadjusted analyses. Only hsCRP remained significantly associated with fatigue levels in the fully adjusted models (p=.020). Depression and self-rated health also remained independently associated with fatigue; however these variables were not significantly associated with hsCRP in multivariate analyses. CONCLUSION: In general, and after adjustment for potential confounders, our hypotheses of positive associations between fatigue and several inflammatory markers were not confirmed. However, a small but independent association between level of fatigue and hsCRP was observed and supports the hypothesis that low-grade inflammation could play a role in the pathogenesis of fatigue in BCSs.

Levels of circulating interleukin-1 receptor antagonist and C-reactive protein in long-term survivors of testicular cancer with chronic cancer-related fatigue.

Low-grade inflammatory responses may be related to the pathogenesis of cancer-related fatigue (CRF). We investigated circulating levels of various inflammatory markers in relation to chronic CRF (6 month duration) in Norwegian long-term survivors of testicular cancer (TCSs). We compared 92 TCSs with chronic CRF (cases) to 191 TCS without (controls) at median age 45 years (range 23-73), and median 11 years post-treatment (range 5-20). Chronic CRF was defined using the Fatigue Questionnaire, while plasma concentrations of cytokines and serum CRP were determined by various immunoassays. Higher levels of interleukin-1 receptor antagonist (IL-1ra) (p=.002) and C-Reactive protein (CRP) (p=.036) were found in cases compared to controls. No differences were observed for interleukin-6 (IL-6), soluble Tumor Necrosis Factor Receptor type 1 (sTNF-R1) or neopterin. Both IL-1ra and CRP were correlated with physical but not with mental fatigue. In logistic regression analyses IL-1ra and CRP explained 3.5% and 2.8%, respectively, of the variance in chronic CRF. Single adjustments for depression, anxiety and neuroticism each raised the models' explained variance to approximately 35%. Those factors did not significantly alter the relationship between chronic CRF and IL-1ra/CRP. BMI and smoking emerged as possible confounding factors. These results indicate that chronic CRF in TCSs is associated with higher levels of circulating IL-1ra and CRP, possibly mediated by physiological morbidity. Hence, the findings lend some support to the hypothesis that low-grade inflammatory processes are involved in the pathogenesis of chronic CRF in cancer survivors.

Chronic cancer-related fatigue in long-term survivors of testicular cancer.

OBJECTIVE: High prevalence of cancer-related fatigue (CRF) has been reported among many groups of cancer survivors when compared to the general population. However, this topic has rarely been studied in long-term survivors of testicular cancer (TCSs). The present multi-centre study examines the prevalence of chronic CRF in Norwegian TCSs compared to chronic general fatigue (GF) in the Norwegian general population, and associations between a variety of relevant variables and CRF in TCSs. METHODS: Participants were 1431 TCSs, aged 18-75, at an average of 11 years posttreatment (range 4.5-21 years), and a sample of 1080 age-matched men from the general Norwegian population (GenPop). The participants responded to a mailed questionnaire that included the Fatigue Questionnaire for the assessment of chronic CRF and chronic GF. RESULTS: The prevalence of chronic CRF was 17.1% (95% CI 15.2-19.1%) among TCSs compared to 9.7% of chronic GF in GenPop (95% CI 8.0-11.5%). Regression analyses showed that poor quality of life (QOL), various psychosocial and somatic problems, and neuroticism were highly associated with presence of chronic CRF in TCSs. CONCLUSION: Chronic CRF is far more common among TCSs than chronic GF in the general population and is associated with poor QOL and multiple psychological and somatic health problems. As a consequence, fatigue should be in focus during routine follow-ups as well as later in the general medical care of TCSs.

Psychological selection of Antarctic personnel: the "SOAP" instrument.

INTRODUCTION: The potential advantage of including a psychological test battery in the selection process for service in the Antarctic was examined in 348 applicants for employment in Antarctica with the British Antarctic Survey (BAS). METHODS: Applicants were screened with the Selection of Antarctic Personnel battery (SOAP) consisting of nine well-known psychological instruments. The SOAP scores were not revealed to the BAS selection panel members, who based the selection on operational criteria, interview, and a general medical examination. The SOAP scores of those selected (n = 177) were further compared with station commanders' reports of winter adaptation (n = 140), and subjective health complaints (SHC) (n = 86). RESULTS: There were no significant agreements between SOAP scores (n = 348) and those actually selected by the BAS panel (121 accepted, 227 not accepted) (Cohen's Kappas for inter-rater agreement < 0.20). Participants characterized as exceptionally well adapted by the station commanders had higher scores on Openness on the NEO-FFI (the "Big Five" personality inventory) [Odds Ratio (OR) = 5.2], and higher levels of Emotion-Focused Coping (OR = 2.7) and fewer SHC (OR = 0.3). Participants rated by station commanders as "poor" had higher levels of Defensive Hostility (OR = 4.2), and lower levels of Emotion-Focused Coping (OR = 0.3). Women had higher rates of success in service than men, but were less likely to be selected. DISCUSSION AND CONCLUSION: Adding a psychological test battery would improve the odds of selecting good performers, and reduce the odds of selecting poor performers.