title: C-reactive protein, symptoms and activity of daily living in patients with advanced cancer receiving palliative care.
abstract: BACKGROUND
  The association between C-reactive protein (CRP) level, symptoms, and activities of daily living (ADL) in advanced cancer patients is unclear.
  
  
  METHODS
  Secondary data analysis of a multicenter prospective cohort study consisted of 2426 advanced cancer patients referred to palliative care settings was conducted to examine the cross-sectional relationships between CRP level, symptoms, and ADL disabilities. Laboratory data, symptoms, ADL, and manual muscle testing (MMT) results were obtained at baseline. Participants were divided into four groups: low (CRP < 1 mg/dl), moderate (1 = < CRP <5 mg/dl), high (5 = < CRP < 10 mg/dl), and very high CRP (10 mg/dl = < CRP). The proportions of eight symptoms, five ADL disabilities, and three categories of MMT according to the CRP groups were tested by chi-square tests. Multiple-adjusted odd ratios (ORs) were calculated by using ordinal logistic regression after adjustment for age, gender, site of primary cancer, metastatic disease, performance status, chemotherapy, and setting of care.
  
  
  RESULTS
  A total of 1702 patients were analysed. Positive rates of symptoms and ADL disabilities increased with increasing CRP level. In the very high-CRP group, rates of positivity for anorexia, fatigue, and weight loss were 89.8%, 81.0%, and 79.2%, respectively, and over 70% of patients received assistance for bathing, dressing, going to the toilet, and transfer. The grade of MMT also deteriorated with increasing CRP level. Adjusted ORs for the accumulated symptoms significantly increased with increasing CRP level in the moderate-CRP, high-CRP, and very high-CRP groups [1.6 (95% confidence interval 1.2-2.0), P < 0.001; 2.5 (1.9-3.2), P < 0.001; 3.5 (2.7-4.6), P < 0.001, respectively]. Adjusted ORs for the accumulated ADL disabilities significantly increased in the very high-CRP groups [2.1 (1.5-2.9), P < 0.001].
  
  
  CONCLUSIONS
  Associations between CRP level, symptoms, and ADL were observed in advanced cancer patients receiving palliative care.
authors.affiliation: Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, 534-0021, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Amano
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Isseki
authors.initials: I
authors.lastname: Maeda
authors.affiliation: Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Morita
authors.affiliation: Department of Palliative Care, Saito Yukoukai Hospital, 7-2-18 Saito Asagi, Ibaragi, Osaka, 567-0085, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.affiliation: Department of Palliative Medicine, National Cancer Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chibay, 277-8577, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Palliative Care Team, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hama
authors.affiliation: Gratia Hospital Hospice, 6-14-1 Aomadaninishi, Mino, Osaka, 562-8567, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Mori
authors.affiliation: Department of Palliative Medicine, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Nakajima
authors.affiliation: Kawasaki Comprehensive Care Center, Kawasaki Municipal Ida Hospital, 2-27-1 Ida Nakahara-ku, Kawasaki, Kanagawa, 211-0035, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Nishi
authors.affiliation: Department of Palliative Care, St. Luke's International Hospital, Tokyo, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakurai
authors.affiliation: Department of Palliative Care, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
authors.forename: Satofumi
authors.initials: S
authors.lastname: Shimoyama
authors.affiliation: Shinjo Clinic, Kobe, 1-5-1-307 Kitagoyou, Kita-ku, Kobe, Hyogo, 651-1131, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Shinjo
authors.affiliation: Osaka Kita Homecare Clinic, Shin-Osaka 3rd Doi-biru 3F, 1-8-24 Nisimiyahara Yodogawa-ku, Osaka, 532-0004, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shirayama
authors.affiliation: Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ono
authors.affiliation: Megumi Zaitaku Clinic, 2-4-3 Hashido, Seya-ku, Yokohama, Kanagawa, 246-0037, Japan.
authors.forename: Taketoshi
authors.initials: T
authors.lastname: Ozawa
authors.affiliation: Department of Palliative Medicine, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 385-0051, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamamoto
authors.affiliation: Department of Primary Care Service, Shinsei Hospital, 851 Obusechou, Kamitakai-gun, Nagano, 381-0295, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Shishido Internal Medicine Clinic, 1-18-7 Ojidai, Sakura, Chiba, 285-0837, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shishido
authors.affiliation: Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010166:Palliative Care / Q000379:methods; D011446:Prospective Studies; D063189:Symptom Assessment
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Activities of daily living; Advanced cancer patients; C-reactive protein; Cancer cachexia; Palliative care; Symptoms