Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia

Basil O. Burney, Teresa G. Hayes, Joanna Smiechowska, Gina Cardwell, Victor Papusha, Peeyush Bhargava, Bhavana Konda, Richard J. Auchus, Jose M. Garcia

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Context: Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established. Objective: The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden. Design/Setting: This cross-sectional study enrolled patients from a tertiary-care center. Subjects/Outcome Measures: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function). Results: Low testosterone levels were seen in more than 70% of CC cases. TT was lower in CC compared to CNC (P< 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients. Conclusions: CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.

Original languageEnglish (US)
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Cachexia
Testosterone
Neoplasms
C-Reactive Protein
Inflammation
Karnofsky Performance Status
Oncology
Hand Strength
Albumins
Interleukin-6
Fats
Hypogonadism
Carbon Monoxide
Tertiary Care Centers
Regression analysis
Fatigue
Muscle
Anti-Inflammatory Agents
Cross-Sectional Studies

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia. / Burney, Basil O.; Hayes, Teresa G.; Smiechowska, Joanna; Cardwell, Gina; Papusha, Victor; Bhargava, Peeyush; Konda, Bhavana; Auchus, Richard J.; Garcia, Jose M.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 5, 01.05.2012.

Research output: Contribution to journalArticle

Burney, Basil O. ; Hayes, Teresa G. ; Smiechowska, Joanna ; Cardwell, Gina ; Papusha, Victor ; Bhargava, Peeyush ; Konda, Bhavana ; Auchus, Richard J. ; Garcia, Jose M. / Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia. In: Journal of Clinical Endocrinology and Metabolism. 2012 ; Vol. 97, No. 5.
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abstract = "Context: Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established. Objective: The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden. Design/Setting: This cross-sectional study enrolled patients from a tertiary-care center. Subjects/Outcome Measures: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function). Results: Low testosterone levels were seen in more than 70{\%} of CC cases. TT was lower in CC compared to CNC (P< 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients. Conclusions: CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.",
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T1 - Low testosterone levels and increased inflammatory markers in patients with cancer and relationship with cachexia

AU - Burney, Basil O.

AU - Hayes, Teresa G.

AU - Smiechowska, Joanna

AU - Cardwell, Gina

AU - Papusha, Victor

AU - Bhargava, Peeyush

AU - Konda, Bhavana

AU - Auchus, Richard J.

AU - Garcia, Jose M.

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N2 - Context: Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established. Objective: The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden. Design/Setting: This cross-sectional study enrolled patients from a tertiary-care center. Subjects/Outcome Measures: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function). Results: Low testosterone levels were seen in more than 70% of CC cases. TT was lower in CC compared to CNC (P< 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients. Conclusions: CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.

AB - Context: Male cancer patients suffer from fatigue, sexual dysfunction, and decreased functional performance and muscle mass. These symptoms are seen in men with hypogonadism and/or inflammatory conditions. However, the relative contribution of testosterone and inflammation to symptom burden in cancer has not been well-established. Objective: The aim of this study was to measure testosterone levels in male cancer patients and determine the relationship between testosterone, inflammation, and symptom burden. Design/Setting: This cross-sectional study enrolled patients from a tertiary-care center. Subjects/Outcome Measures: Subjects included males with cancer-cachexia (CC; n = 45) and cancer without cachexia (CNC; n = 50), as well as noncancer controls (CO; n = 45). Total testosterone (TT), bioavailable testosterone, C-reactive protein (CRP), and IL-6 were measured in plasma. Functional performance was assessed by the ECOG (Eastern Cooperative Oncology Group) and KPS (Karnofsky Performance Scales), and sexual function was assessed by the IIEF (International Index of Erectile Function). Results: Low testosterone levels were seen in more than 70% of CC cases. TT was lower in CC compared to CNC (P< 0.05). Also, CC had lower bioavailable testosterone, grip strength, IIEF scores, appendicular lean body mass, and fat mass and higher IL-6 and CRP compared to controls (P ≤ 0.05). ECOG and KPS were lower in CC and CNC compared to controls (P ≤ 0.05). On multiple regression analysis, TT, albumin, and CRP predicted symptoms differentially in cancer patients. Conclusions: CC patients have higher inflammation and lower testosterone, grip strength, functional status, erectile function, fat mass, and appendicular lean body mass. Inflammation, TT, and albumin are associated with heavier symptom burden in this population. Interventional trials are needed to determine whether testosterone replacement and/or antiinflammatory agents benefit cancer patients.

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