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C-reactive protein predicts fatigue independently of depression in breast cancer patients prior to chemotherapy

Pertl MM, Hevey D, Boyle NT, Hughes MM, Collier S, O'Dwyer AM, Harkin A, Kennedy MJ, Connor TJ.

Brain, Behavior, and Immunity, Volume 34, November 2013, Pages 108–119

Editors' comments: Dr. Ricardo Caponero 

Cancer-related fatigue continues to be a major concern of patients and providers of cancer care. The symptoms are debilitating and can persist for many years after the cancer diagnosis and therapy. 
Attention must be focused on understanding which comorbidities contribute to Cancer-related fatigue.
Heightened inflammatory activity has been proposed as a mechanism for the development of cancer-related fatigue, a common and distressing condition that can negatively affect quality of life.
Inflammation is also implicated in the pathogenesis of depression, and depression is a strong predictor of cancer-related fatigue. Thus, the role of the pro-inflammatory cytokine network in cancer-related fatigue may be mediated by depression or both conditions may share similar underlying physiological processes.
Kynurenine levels pre- and post-treatment significantly predicted changes in depression, suggesting that heightened kynurenine pathway activation may contribute to depressive symptoms in patients treated for cancer.