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The Relationship Between Inflammatory Biomarkers and Symptom Distress in Lung Cancer Patients Undergoing Chemotherapy

Chou, Hsiu-Ling PhD, RN; Chao, Tsu-Yi PhD, MD; Chen, Tsan-Chi PhD; Chu, Chi-Ming PhD; Hsieh, Chen-Hsi PhD, MD; Yao, Chung-Tay MD; Janckila, Anthony J. PhD

doi: 10.1097/NCC.0000000000000369
Articles: Online Only

Background: Symptom distress often occurs in lung cancer patients undergoing chemotherapy. However, a biomarker has not been identified to reflect the severity of their symptom distress.

Objective: The aim of this study was to investigate the relationship between symptom distress and serum inflammatory biomarkers in lung cancer patients undergoing chemotherapy.

Methods: A longitudinal, repeated-measures design was used to assess subjective symptoms (fatigue, sleep disturbance, pain, depression, and confusion), serum biomarkers (tartrate-resistant acid phosphatase 5a [TRACP5a], interleukin 6 [IL-6], IL-8, and C-reactive protein), and white blood cells in 62 lung cancer patients recruited from a single medical center at 3 time points: T1 was the baseline, T2 was the eighth day after the first chemotherapy cycle, and T3 was prior to the second cycle. Symptom distress was measured individually by 5 questionnaires (General Fatigue Scale, Pittsburgh Sleep Quality Index, Brief Pain Inventory, Profile of Mood States–Depressive, and Confusion).

Results: The trend of TRACP5a was positively correlated to the trend of the patients’ symptom distress. However, the trends of IL-6 and IL-8 did not correlate.

Conclusions: Serum TRACP5a was associated with symptom distress in lung cancer patients. Therefore, TRACP5a might be a potential biomarker to assess symptom distress of lung cancer patients undergoing chemotherapy.

Implications for Practice: Oncology nurses may be able to apply TRACP5a expression to predict or monitor multiple distress symptoms in lung cancer patients undergoing chemotherapy. Furthermore, nurses can use these study findings to better understand the patients who need more attention to improve their quality of life.

Author Affiliations: Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, and School of Nursing, National Yang-Ming University, Taipei (Dr Chou); Department of Nursing, Oriental Institute of Technology (Drs Chou and Yao); Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University-Shuang Ho Hospital (Dr Chao); and Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City (Dr Chen); Division of Biomedical Statistics and Informatics, School of Public Health at National Defense Medical Center, Taipei (Dr Chu); Department of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, and Department of Medicine, National Yang-Ming University, Taipei (Dr Hsieh); and Department of Emergency, Cathay General Hospital, Taipei, and School of Medicine, Fu-Jen Catholic University, New Taipei City (Dr Yao), Taiwan; and Division of Hematology, Veterans Administrative Medical Center, Louisville, Kentucky (Dr Janckila).

The authors have no funding or conflicts of interest to disclose.

Correspondence: Chung-Tay Yao, MD, Department of Emergency, Cathay General Hospital, 280, Renai Rd Section 4, Taipei, Taiwan (

Accepted for publication February 4, 2016.

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