TY - JOUR
T1 - Inflammation is a mediating factor in the association between lifestyle and fatigue in colorectal cancer patients
AU - Wesselink, Evertine
AU - van Baar, Harm
AU - van Zutphen, Moniek
AU - Tibosch, Meilissa
AU - Kouwenhoven, Ewout A.
AU - Keulen, Eric T.P.
AU - Kok, Dieuwertje E.
AU - van Halteren, Henk K.
AU - Breukink, Stephanie O.
AU - de Wilt, Johannes H.W.
AU - Weijenberg, Matty P.
AU - Kenkhuis, Marlou Floor
AU - Balvers, Michiel G.J.
AU - Witkamp, Renger F.
AU - van Duijnhoven, Fränzel J.B.
AU - Kampman, Ellen
AU - Beijer, Sandra
AU - Bours, Martijn J.L.
AU - Winkels, Renate M.
PY - 2020/12
Y1 - 2020/12
N2 - Fatigue is very common among colorectal cancer (CRC) patients. We examined the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and fatigue among stage I-III CRC patients, and whether inflammation mediated this association. Data from two prospective cohort studies were used. Adherence to the WCRF/AICR recommendations was expressed as a score ranging from 0–7, and assessed shortly after diagnosis. Six months post-diagnosis, fatigue was assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire C30 (EORTC QLQ-C30), and in a subpopulation, the plasma levels of inflammation markers (IL6, IL8, TNFα, and hsCRP) were assessed. Multiple linear regression analyses were performed to investigate the association between adherence to the WCRF/AICR recommendations and fatigue. To test mediation by inflammation, the PROCESS analytic tool developed by Hayes was used. A higher WCRF/AICR adherence score was associated with less fatigue six months after diagnosis (n = 1417, β −2.22, 95%CI −3.65; −0.78). In the population of analysis for the mediation analyses (n = 551), the total association between lifestyle and fatigue was (β −2.17, 95% CI −4.60; 0.25). A statistically significant indirect association via inflammation was observed (β −0.97, 95% CI −1.92; −0.21), explaining 45% of the total association between lifestyle and fatigue (−0.97/−2.17 × 100). Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.
AB - Fatigue is very common among colorectal cancer (CRC) patients. We examined the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and fatigue among stage I-III CRC patients, and whether inflammation mediated this association. Data from two prospective cohort studies were used. Adherence to the WCRF/AICR recommendations was expressed as a score ranging from 0–7, and assessed shortly after diagnosis. Six months post-diagnosis, fatigue was assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire C30 (EORTC QLQ-C30), and in a subpopulation, the plasma levels of inflammation markers (IL6, IL8, TNFα, and hsCRP) were assessed. Multiple linear regression analyses were performed to investigate the association between adherence to the WCRF/AICR recommendations and fatigue. To test mediation by inflammation, the PROCESS analytic tool developed by Hayes was used. A higher WCRF/AICR adherence score was associated with less fatigue six months after diagnosis (n = 1417, β −2.22, 95%CI −3.65; −0.78). In the population of analysis for the mediation analyses (n = 551), the total association between lifestyle and fatigue was (β −2.17, 95% CI −4.60; 0.25). A statistically significant indirect association via inflammation was observed (β −0.97, 95% CI −1.92; −0.21), explaining 45% of the total association between lifestyle and fatigue (−0.97/−2.17 × 100). Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.
KW - Colorectal cancer
KW - Fatigue
KW - Inflammation markers
KW - Lifestyle
KW - Mediation analyses
U2 - 10.3390/cancers12123701
DO - 10.3390/cancers12123701
M3 - Article
AN - SCOPUS:85098526001
SN - 2072-6694
VL - 12
SP - 1
EP - 13
JO - Cancers
JF - Cancers
IS - 12
M1 - 3701
ER -
