title: Association between hypogonadism, symptom burden, and survival in male patients with advanced cancer.
abstract: BACKGROUND
  A high frequency of hypogonadism has been reported in male patients with advanced cancer. The current study was performed to evaluate the association between low testosterone levels, symptom burden, and survival in male patients with cancer.
  
  
  METHODS
  Of 131 consecutive male patients with cancer, 119 (91%) had an endocrine evaluation of total (TT), free (FT), and bioavailable testosterone (BT); high-sensitivity C-reactive protein (CRP); vitamin B12; thyroid-stimulating hormone; 25-hydroxy vitamin D; and cortisol levels when presenting with symptoms of fatigue and/or anorexia-cachexia. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. The authors examined the correlation using the Spearman test and survival with the log-rank test and Cox regression analysis.
  
  
  RESULTS
  The median age of the patients was 64 years; the majority of patients were white (85 patients; 71%). The median TT level was 209 ng/dL (normal: ≥ 200 ng/dL), the median FT was 4.4 ng/dL (normal: ≥ 9 ng/dL), and the median BT was 22.0 ng/dL (normal: ≥ 61 ng/dL). Low TT, FT, and BT values were all associated with worse fatigue (P ≤ .04), poor Eastern Cooperative Oncology Group performance status (P ≤ .05), weight loss (P ≤ .01), and opioid use (P ≤ .005). Low TT and FT were associated with increased anxiety (P ≤ .04), a decreased feeling of well-being (P ≤ .04), and increased dyspnea (P ≤ .05), whereas low BT was only found to be associated with anorexia (P = .05). Decreased TT, FT, and BT values were all found to be significantly associated with elevated CRP and low albumin and hemoglobin. On multivariate analysis, decreased survival was associated with low TT (hazards ratio [HR], 1.66; P = .034), declining Eastern Cooperative Oncology Group performance status (HR, 1.55; P = .004), high CRP (HR, 3.28; P < .001), and decreased albumin (HR, 2.52; P < .001).
  
  
  CONCLUSIONS
  In male patients with cancer, low testosterone levels were associated with systemic inflammation, weight loss, increased symptom burden, and decreased survival. A high frequency of hypogonadism has been reported in male patients with advanced cancer. In the current study, an increased symptom burden, systemic inflammation, weight loss, opioid use, and poor survival were found to be associated with decreased testosterone levels in male patients with cancer. Cancer 2014;120:1586-1593. © 2014 American Cancer Society.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Rony
authors.initials: R
authors.lastname: Dev
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.forename: Egidio
authors.initials: E
authors.lastname: Del Fabbro
authors.forename: Marvin O
authors.initials: MO
authors.lastname: Delgado-Guay
authors.forename: Nikhil
authors.initials: N
authors.lastname: Sobti
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000728:Androgens / Q000097:blood; D000855:Anorexia / Q000150:complications / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002100:Cachexia / Q000150:complications / Q000209:etiology; D017281:Cost of Illness; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007006:Hypogonadism / Q000097:blood* / Q000209:etiology*; D007249:Inflammation / Q000097:blood / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000401:mortality*; D011788:Quality of Life; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D013739:Testosterone / Q000097:blood*; D013781:Texas / Q000453:epidemiology; D013972:Thyrotropin / Q000097:blood; D014805:Vitamin B 12 / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D015431:Weight Loss
chemical_list: D000701:Analgesics, Opioid; D000728:Androgens; D015415:Biomarkers; D006454:Hemoglobins; D012709:Serum Albumin; D014807:Vitamin D; D013739:Testosterone; D013972:Thyrotropin; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D; D014805:Vitamin B 12; D006854:Hydrocortisone
keywords: advanced cancer; hypogonadism; palliative care; survival; symptom management