Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer

Weight loss and the acute-phase response have been associated with poor qua lity of life and survival in advanced pancreatic cancer; however, little in formation is available on changes in these factors over time and their inte rrelationships. This study examined changes in weighs, Karnofsky performanc e status, C-reactive protein (CRP), and serum albumin in 25 patients with a dvanced pancreatic cancer given supportive symptomatic treatment only. Pati ents were assessed at approximately monthly intervals on a total of 70 occa sions, allowing assessment of changes over 37 intervals. Overall, patients had a median weighs loss of 2.3 kg/28 days. Median CRP levels rose by 15 mg /l, and serum albumin fell by I g/l on average over 28 days. Karnofsky perf ormance status fell by 4 points every 28 days. The nine patients assessed c lose to death were compared with the 13 assessed close to diagnosis. The in crease in CRP level and fall in weight and performance status were signific antly greater within eight weeks of death than within eight weeks of diagno sis. Among patients close to diagnosis, 13% had an elevated CRP compared wi th 100% of those close to death. In multivariate analysis, Karnofsky perfor mance status was significantly associated with percent weight loss and CRP levels. These data further implicate the acute-phase protein response as be ing associated with the progressive weight loss seen in patients with advan ced pancreatic cancer. Changes appear to accelerate close to death. Moreove r, the development of cachexia is associated with a reduction in patients' functional capacity.