Evidence map›Paper›PMID 29360570›Full record

Trial reportJournal of pain and symptom management2018

The Role of Inflammation in the Pain, Fatigue, and Sleep Disturbance Symptom Cluster in Advanced Cancer.

Kristine L Kwekkeboom, Lauren Tostrud, Erin Costanzo, Christopher L Coe, Ronald C Serlin, Sandra E Ward, Yingzi Zhang

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of pain and symptom management, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
77citing papers in PubMed, 10 pooled it
4.4field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

77 citing papers in PubMed, 10 syntheses or guidelines pooled it, 127 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Trial
  12. Effects of self-acupressure on the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a phase III randomised controlled trial.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Trial
  13. Trial
  14. Trial
  15. Trial
  16. Article
  17. Article
  18. Beyond tumor biology: nursing interventions for psychological and immune health in cancer patients.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Review
  19. Using confirmatory factor analysis to identify symptom clusters in individuals with acquired disabilities.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026
    Article
  20. Article

17 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Kristine L KwekkeboomUniversity of Wisconsin, Madison, Wisconsin, USA. Electronic address: kwekkeboom@wisc.edu.
Lauren TostrudUniversity of Wisconsin, Madison, Wisconsin, USA.
Erin CostanzoUniversity of Wisconsin, Madison, Wisconsin, USA.
Christopher L CoeUniversity of Wisconsin, Madison, Wisconsin, USA.
Ronald C SerlinUniversity of Wisconsin, Madison, Wisconsin, USA.
Sandra E WardUniversity of Wisconsin, Madison, Wisconsin, USA.
Yingzi ZhangUniversity of Wisconsin, Madison, Wisconsin, USA.
University of Wisconsin–Madison · US

Funding

Statistical Data Enclave CoreP30AG017266 · NIA · UNIVERSITY OF WISCONSIN-MADISON · PI Michal Engelman · 1999 to 2026
$17.0M
A Brief Patient-Controlled Intervention for a Symptom Cluster in Advanced CancerR01NR013468 · NINR · UNIVERSITY OF WISCONSIN-MADISON · PI KWEKKEBOOM, KRISTINE L · 2013 to 2016
$2.0M
NINR NIH HHS R01 NR013468
6 · The paper itself

Abstract

contextSymptom researchers have proposed a model of inflammatory cytokine activity and dysregulation in cancer to explain co-occurring symptoms including pain, fatigue, and sleep disturbance.

objectivesWe tested the hypothesis that psychological stress accentuates inflammation and that stress and inflammation contribute to one's experience of the pain, fatigue, and sleep disturbance symptom cluster (symptom cluster severity, symptom cluster distress) and its impact (symptom cluster interference with daily life, quality of life).

methodsWe used baseline data from a symptom cluster management trial. Adult participants (N = 158) receiving chemotherapy for advanced cancer reported pain, fatigue, and sleep disturbance on enrollment. Before intervention, participants completed measures of demographics, perceived stress, symptom cluster severity, symptom cluster distress, symptom cluster interference with daily life, and quality of life and provided a blood sample for four inflammatory biomarkers (interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein).

resultsStress was not directly related to any inflammatory biomarker. Stress and tumor necrosis factor-α were positively related to symptom cluster distress, although not symptom cluster severity. Tumor necrosis factor-α was indirectly related to symptom cluster interference with daily life, through its effect on symptom cluster distress. Stress was positively associated with symptom cluster interference with daily life and inversely with quality of life. Stress also had indirect effects on symptom cluster interference with daily life, through its effect on symptom cluster distress.

conclusionThe proposed inflammatory model of symptoms was partially supported. Investigators should test interventions that target stress as a contributing factor in co-occurring pain, fatigue, and sleep disturbance and explore other factors that may influence inflammatory biomarker levels within the context of an advanced cancer diagnosis and treatment.

Indexed as

AdultAgedAntineoplastic AgentsBiomarkersCognitive Behavioral TherapyFatigueFemaleHumansInflammationMaleMiddle AgedModels, BiologicalNeoplasmsPainPain ManagementQuality of LifeAntineoplastic AgentsBiomarkersCancerinflammationpsychological stressquality of lifesymptom cluster

Identifiers

PMID29360570
PMCPMC5899940
OpenAlexW2783811473

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.