{"id":{"repo_id":"edinburgh","oai_identifier":"oai:era.ed.ac.uk:1842/43506"},"canonical_url":"https://search.dev.ndltd.org/etd/edinburgh/oai:era.ed.ac.uk:1842/43506","repository":{"repo_id":"edinburgh","name":"University of Edinburgh","base_url":"https://era.ed.ac.uk/server/oai/request"},"display":{"title":"Role of the systemic inflammatory response in the clinical and biological features of incurable cancer and cachexia","abstract":"BACKGROUND: The influence of the immune system and inflammation in the development of cancer is widely accepted. The same inflammatory processes are also involved in the evolution of the clinical features of cancer. Cachexia, a syndrome of muscle and fat loss not easily reversed by changes in nutrition, is amongst the most common and devastating features of cancer, especially incurable cancer. People with incurable cancer are an understudied population, and crucial questions remain regarding the cachexia syndrome in this group. Further foundational work to examine the biochemical and clinical features of cachexia is required in order to inform therapeutic trials and develop meaningful interventions to improve quality of life. AIMS: The overall aim of this thesis was to examine the biological and clinical features of cancer cachexia and incurable cancer with a focus on the role of inflammation. In order to achieve this aim, reviews of the current literature were conducted. A prospective observational study (Routine Evaluation of People Living with Cancer- REVOLUTION study) was also undertaken. Five key areas were addressed in the REVOLUTION study- physical function, symptoms, quality of life, body composition and inflammation. METHODS: Two systematic reviews were conducted. The first of which, described in chapter two, examined the relationship between circulating cytokines and symptoms in incurable cancer. The second review, described in chapter three, examined the relationship between circulating cytokines and cachexia/ weight loss in incurable cancer. Quality of studies was assessed in both reviews using a modified Downs and Black checklist detailed in chapter two. The REVOLUTION study was conducted as detailed in chapter four. Patients were recruited from an inpatient hospice setting; were >18 years of age and had a diagnosis of incurable cancer (defined as clinical, histological, or radiological evidence of metastatic cancer, or receiving anti-cancer therapy with palliative intent). Patients were invited to a baseline assessment, with follow-up assessments at six and twelve weeks. Demographic details and measurements of height, weight and body mass index were collected. Body composition was measured using bioimpedance analysis and (if available) analysis of CT images from routine oncology follow up. Physical function was measured objectively using the Karnofsky Performance Status Scale (KPS) and subjectively using the European Organisation for the Research and Treatment of Cancer – Quality of Life Questionnaire –C30 (EORTC QLQ-C30). The EORTC-QLQ-C30 was also used to gather information regarding symptoms and quality of life. The Functional Assessment of Anorexia/ Cachexia Therapy Scale (FAACT) was included to capture information regarding symptoms related to cachexia. To collect data regarding nutrition and physical function the Patient Generated Subjective Global Assessment – Short Form (PGSGA-SF) was included. Blood samples were analysed for simple markers of the systemic inflammatory response and concentrations of multiple pro- and anti-inflammatory cytokines (e.g., Interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-10, IL-17, and Tissue Necrosis Factor-α). RESULTS: Systematic Reviews: IL‐6, TNF‐α, and IL‐8 levels were greater in cachectic patients than in healthy individuals. Several symptoms of incurable cancer were associated with elevated levels of circulating cytokines i.e., depression, fatigue, and appetite loss were all linked with increased levels of IL-6. These results support the suggestion of a role for inflammatory cytokines in symptom generation, however it is difficult to draw further conclusions due to limitations in study methodology. The definition of cachexia and weight loss thresholds adopted across the studies included were highly variable, as were the methods described for cytokine analysis and the instruments used for assessment of symptoms. REVOLUTION Study: Between July 2020 and June 2021 45 patients were recruited to the REVOLUTION study. Mean age was 65 years, (range 39-91). The majority had a KPS score of 50- 70% (50%- requiring help often, requiring frequent medical care, 70% cares for self, unable to do normal activity or to do active work). The most common primary sites of cancer in the population were breast and colorectal cancer. Thirteen patients participated in assessments at time point two, seven patients participated in assessments at time point three. The most common reason for non-completion was death. Cachexia was not a pre-requisite for recruitment to the study however at baseline 60% of patients were cachectic using a 5% weight loss threshold. In keeping with this finding, the FAACT and PGSGA-SF mean questionnaire scores revealed a high level of nutritional impact symptoms and a significant need for intervention. At baseline using the EORTC-QLQ-C30, patients had a low overall global health status mean score (37.6/100). In terms of cytokine analysis GDF-15 (r=0.511, p=0.004) and IL-1ra (r=0.492, p=0.002) had a significant relationship with BMI. There was a strong correlation between IL-6 levels and constipation (r=0.663, p=<0.01) and a moderate correlation between IL-8 levels and nausea and vomiting (r=0.486, p=0.002) and between TNF-α and diarrhoea (r=0.409, p=0.34). The study adopted a patient-centred approach in order to optimise patient involvement, however this made it more challenging to obtain consistent standardised measurements. CONCLUSION: Results of the systematic reviews suggest links between the systemic inflammatory response, cancer cachexia and the symptoms of incurable cancer. As inflammatory signalling patterns are dynamic, involving cytokines with myriad functions, a standardised longitudinal approach to further research is likely to be required to disentangle these complex relationships. The findings of the REVOLUTION study reinforce the idea that cancer cachexia extends beyond mere weight loss, involving factors such as inflammation, nutritional status, and muscle wasting. The study's exploration of cytokines, such as GDF-15 and IL-1ra, revealed potential links to BMI and suggested these biomarkers could be crucial in understanding cancer cachexia. In an exploration of the symptoms of incurable cancer it was found that nutritional impact symptoms were common and had links with higher levels of inflammatory cytokines such as IL-6, IL-8 and TNF-α. This study provides a foundation for further research to understand the lived experience of incurable cancer and cancer cachexia","abstract_html":"BACKGROUND: The influence of the immune system and inflammation in the development of cancer is widely accepted. The same inflammatory processes are also involved in the evolution of the clinical features of cancer. Cachexia, a syndrome of muscle and fat loss not easily reversed by changes in nutrition, is amongst the most common and devastating features of cancer, especially incurable cancer. People with incurable cancer are an understudied population, and crucial questions remain regarding the cachexia syndrome in this group. Further foundational work to examine the biochemical and clinical features of cachexia is required in order to inform therapeutic trials and develop meaningful interventions to improve quality of life. AIMS: The overall aim of this thesis was to examine the biological and clinical features of cancer cachexia and incurable cancer with a focus on the role of inflammation. In order to achieve this aim, reviews of the current literature were conducted. A prospective observational study (Routine Evaluation of People Living with Cancer- REVOLUTION study) was also undertaken. Five key areas were addressed in the REVOLUTION study- physical function, symptoms, quality of life, body composition and inflammation. METHODS: Two systematic reviews were conducted. The first of which, described in chapter two, examined the relationship between circulating cytokines and symptoms in incurable cancer. The second review, described in chapter three, examined the relationship between circulating cytokines and cachexia/ weight loss in incurable cancer. Quality of studies was assessed in both reviews using a modified Downs and Black checklist detailed in chapter two. The REVOLUTION study was conducted as detailed in chapter four. Patients were recruited from an inpatient hospice setting; were >18 years of age and had a diagnosis of incurable cancer (defined as clinical, histological, or radiological evidence of metastatic cancer, or receiving anti-cancer therapy with palliative intent). Patients were invited to a baseline assessment, with follow-up assessments at six and twelve weeks. Demographic details and measurements of height, weight and body mass index were collected. Body composition was measured using bioimpedance analysis and (if available) analysis of CT images from routine oncology follow up. Physical function was measured objectively using the Karnofsky Performance Status Scale (KPS) and subjectively using the European Organisation for the Research and Treatment of Cancer – Quality of Life Questionnaire –C30 (EORTC QLQ-C30). The EORTC-QLQ-C30 was also used to gather information regarding symptoms and quality of life. The Functional Assessment of Anorexia/ Cachexia Therapy Scale (FAACT) was included to capture information regarding symptoms related to cachexia. To collect data regarding nutrition and physical function the Patient Generated Subjective Global Assessment – Short Form (PGSGA-SF) was included. Blood samples were analysed for simple markers of the systemic inflammatory response and concentrations of multiple pro- and anti-inflammatory cytokines (e.g., Interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-10, IL-17, and Tissue Necrosis Factor-α). RESULTS: Systematic Reviews: IL‐6, TNF‐α, and IL‐8 levels were greater in cachectic patients than in healthy individuals. Several symptoms of incurable cancer were associated with elevated levels of circulating cytokines i.e., depression, fatigue, and appetite loss were all linked with increased levels of IL-6. These results support the suggestion of a role for inflammatory cytokines in symptom generation, however it is difficult to draw further conclusions due to limitations in study methodology. The definition of cachexia and weight loss thresholds adopted across the studies included were highly variable, as were the methods described for cytokine analysis and the instruments used for assessment of symptoms. REVOLUTION Study: Between July 2020 and June 2021 45 patients were recruited to the REVOLUTION study. Mean age was 65 years, (range 39-91). The majority had a KPS score of 50- 70% (50%- requiring help often, requiring frequent medical care, 70% cares for self, unable to do normal activity or to do active work). The most common primary sites of cancer in the population were breast and colorectal cancer. Thirteen patients participated in assessments at time point two, seven patients participated in assessments at time point three. The most common reason for non-completion was death. Cachexia was not a pre-requisite for recruitment to the study however at baseline 60% of patients were cachectic using a 5% weight loss threshold. In keeping with this finding, the FAACT and PGSGA-SF mean questionnaire scores revealed a high level of nutritional impact symptoms and a significant need for intervention. At baseline using the EORTC-QLQ-C30, patients had a low overall global health status mean score (37.6/100). In terms of cytokine analysis GDF-15 (r=0.511, p=0.004) and IL-1ra (r=0.492, p=0.002) had a significant relationship with BMI. There was a strong correlation between IL-6 levels and constipation (r=0.663, p=<0.01) and a moderate correlation between IL-8 levels and nausea and vomiting (r=0.486, p=0.002) and between TNF-α and diarrhoea (r=0.409, p=0.34). The study adopted a patient-centred approach in order to optimise patient involvement, however this made it more challenging to obtain consistent standardised measurements. CONCLUSION: Results of the systematic reviews suggest links between the systemic inflammatory response, cancer cachexia and the symptoms of incurable cancer. As inflammatory signalling patterns are dynamic, involving cytokines with myriad functions, a standardised longitudinal approach to further research is likely to be required to disentangle these complex relationships. The findings of the REVOLUTION study reinforce the idea that cancer cachexia extends beyond mere weight loss, involving factors such as inflammation, nutritional status, and muscle wasting. The study's exploration of cytokines, such as GDF-15 and IL-1ra, revealed potential links to BMI and suggested these biomarkers could be crucial in understanding cancer cachexia. In an exploration of the symptoms of incurable cancer it was found that nutritional impact symptoms were common and had links with higher levels of inflammatory cytokines such as IL-6, IL-8 and TNF-α. This study provides a foundation for further research to understand the lived experience of incurable cancer and cancer cachexia","abstract_has_math":false,"creators":["Patton, Rebekah Victoria"],"institution":"The University of Edinburgh","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Laird, Barry","Fallon, Marie","Skipworth, Richard"],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-05-28","date_published":"2025-05-28","updated_at":"2026-07-24T02:13:55Z","subjects":["Systemic Inflammatory Response","Cachexia","Cytokines","Incurable Cancer","REVOLUTION Study"],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://dx.doi.org/10.7488/era/6042"],"render_values":[{"text":"http://dx.doi.org/10.7488/era/6042","href":"http://dx.doi.org/10.7488/era/6042","code":true}]}]},"links":{"outbound_url":"https://hdl.handle.net/1842/43506","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Laird, Barry","Fallon, Marie","Skipworth, Richard"]},{"key":"dc:creator","label":"Author","values":["Patton, Rebekah Victoria"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2025-05-28T14:19:44Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2025-05-28T14:19:44Z"]},{"key":"dc:date.issued","label":"Date","values":["2025-05-28"]},{"key":"dc:publisher","label":"Institution","values":["The University of Edinburgh"]},{"key":"dc:type","label":"Dc Type","values":["Thesis or Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["PhD Doctor of Philosophy"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Systemic Inflammatory Response","Cachexia","Cytokines","Incurable Cancer","REVOLUTION Study"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://hdl.handle.net/1842/43506","http://dx.doi.org/10.7488/era/6042"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["BACKGROUND: The influence of the immune system and inflammation in the development of cancer is widely accepted. The same inflammatory processes are also involved in the evolution of the clinical features of cancer. Cachexia, a syndrome of muscle and fat loss not easily reversed by changes in nutrition, is amongst the most common and devastating features of cancer, especially incurable cancer. People with incurable cancer are an understudied population, and crucial questions remain regarding the cachexia syndrome in this group. Further foundational work to examine the biochemical and clinical features of cachexia is required in order to inform therapeutic trials and develop meaningful interventions to improve quality of life. AIMS: The overall aim of this thesis was to examine the biological and clinical features of cancer cachexia and incurable cancer with a focus on the role of inflammation. In order to achieve this aim, reviews of the current literature were conducted. A prospective observational study (Routine Evaluation of People Living with Cancer- REVOLUTION study) was also undertaken. Five key areas were addressed in the REVOLUTION study- physical function, symptoms, quality of life, body composition and inflammation. METHODS: Two systematic reviews were conducted. The first of which, described in chapter two, examined the relationship between circulating cytokines and symptoms in incurable cancer. The second review, described in chapter three, examined the relationship between circulating cytokines and cachexia/ weight loss in incurable cancer. Quality of studies was assessed in both reviews using a modified Downs and Black checklist detailed in chapter two. The REVOLUTION study was conducted as detailed in chapter four. Patients were recruited from an inpatient hospice setting; were >18 years of age and had a diagnosis of incurable cancer (defined as clinical, histological, or radiological evidence of metastatic cancer, or receiving anti-cancer therapy with palliative intent). Patients were invited to a baseline assessment, with follow-up assessments at six and twelve weeks. Demographic details and measurements of height, weight and body mass index were collected. Body composition was measured using bioimpedance analysis and (if available) analysis of CT images from routine oncology follow up. Physical function was measured objectively using the Karnofsky Performance Status Scale (KPS) and subjectively using the European Organisation for the Research and Treatment of Cancer – Quality of Life Questionnaire –C30 (EORTC QLQ-C30). The EORTC-QLQ-C30 was also used to gather information regarding symptoms and quality of life. The Functional Assessment of Anorexia/ Cachexia Therapy Scale (FAACT) was included to capture information regarding symptoms related to cachexia. To collect data regarding nutrition and physical function the Patient Generated Subjective Global Assessment – Short Form (PGSGA-SF) was included. Blood samples were analysed for simple markers of the systemic inflammatory response and concentrations of multiple pro- and anti-inflammatory cytokines (e.g., Interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-10, IL-17, and Tissue Necrosis Factor-α). RESULTS: Systematic Reviews: IL‐6, TNF‐α, and IL‐8 levels were greater in cachectic patients than in healthy individuals. Several symptoms of incurable cancer were associated with elevated levels of circulating cytokines i.e., depression, fatigue, and appetite loss were all linked with increased levels of IL-6. These results support the suggestion of a role for inflammatory cytokines in symptom generation, however it is difficult to draw further conclusions due to limitations in study methodology. The definition of cachexia and weight loss thresholds adopted across the studies included were highly variable, as were the methods described for cytokine analysis and the instruments used for assessment of symptoms. REVOLUTION Study: Between July 2020 and June 2021 45 patients were recruited to the REVOLUTION study. Mean age was 65 years, (range 39-91). The majority had a KPS score of 50- 70% (50%- requiring help often, requiring frequent medical care, 70% cares for self, unable to do normal activity or to do active work). The most common primary sites of cancer in the population were breast and colorectal cancer. Thirteen patients participated in assessments at time point two, seven patients participated in assessments at time point three. The most common reason for non-completion was death. Cachexia was not a pre-requisite for recruitment to the study however at baseline 60% of patients were cachectic using a 5% weight loss threshold. In keeping with this finding, the FAACT and PGSGA-SF mean questionnaire scores revealed a high level of nutritional impact symptoms and a significant need for intervention. At baseline using the EORTC-QLQ-C30, patients had a low overall global health status mean score (37.6/100). In terms of cytokine analysis GDF-15 (r=0.511, p=0.004) and IL-1ra (r=0.492, p=0.002) had a significant relationship with BMI. There was a strong correlation between IL-6 levels and constipation (r=0.663, p=<0.01) and a moderate correlation between IL-8 levels and nausea and vomiting (r=0.486, p=0.002) and between TNF-α and diarrhoea (r=0.409, p=0.34). The study adopted a patient-centred approach in order to optimise patient involvement, however this made it more challenging to obtain consistent standardised measurements. CONCLUSION: Results of the systematic reviews suggest links between the systemic inflammatory response, cancer cachexia and the symptoms of incurable cancer. As inflammatory signalling patterns are dynamic, involving cytokines with myriad functions, a standardised longitudinal approach to further research is likely to be required to disentangle these complex relationships. The findings of the REVOLUTION study reinforce the idea that cancer cachexia extends beyond mere weight loss, involving factors such as inflammation, nutritional status, and muscle wasting. The study's exploration of cytokines, such as GDF-15 and IL-1ra, revealed potential links to BMI and suggested these biomarkers could be crucial in understanding cancer cachexia. In an exploration of the symptoms of incurable cancer it was found that nutritional impact symptoms were common and had links with higher levels of inflammatory cytokines such as IL-6, IL-8 and TNF-α. This study provides a foundation for further research to understand the lived experience of incurable cancer and cancer cachexia"]},{"key":"dc:title","label":"Title","values":["Role of the systemic inflammatory response in the clinical and biological features of incurable cancer and cachexia"]}]}],"canonical_facts":{"dc:contributor.advisor":["Laird, Barry","Fallon, Marie","Skipworth, Richard"],"dc:creator":["Patton, Rebekah Victoria"],"dc:date.accessioned":["2025-05-28T14:19:44Z"],"dc:date.available":["2025-05-28T14:19:44Z"],"dc:date.issued":["2025-05-28"],"dc:description.abstract":["BACKGROUND: The influence of the immune system and inflammation in the development of cancer is widely accepted. The same inflammatory processes are also involved in the evolution of the clinical features of cancer. Cachexia, a syndrome of muscle and fat loss not easily reversed by changes in nutrition, is amongst the most common and devastating features of cancer, especially incurable cancer. People with incurable cancer are an understudied population, and crucial questions remain regarding the cachexia syndrome in this group. Further foundational work to examine the biochemical and clinical features of cachexia is required in order to inform therapeutic trials and develop meaningful interventions to improve quality of life. AIMS: The overall aim of this thesis was to examine the biological and clinical features of cancer cachexia and incurable cancer with a focus on the role of inflammation. In order to achieve this aim, reviews of the current literature were conducted. A prospective observational study (Routine Evaluation of People Living with Cancer- REVOLUTION study) was also undertaken. Five key areas were addressed in the REVOLUTION study- physical function, symptoms, quality of life, body composition and inflammation. METHODS: Two systematic reviews were conducted. The first of which, described in chapter two, examined the relationship between circulating cytokines and symptoms in incurable cancer. The second review, described in chapter three, examined the relationship between circulating cytokines and cachexia/ weight loss in incurable cancer. Quality of studies was assessed in both reviews using a modified Downs and Black checklist detailed in chapter two. The REVOLUTION study was conducted as detailed in chapter four. Patients were recruited from an inpatient hospice setting; were >18 years of age and had a diagnosis of incurable cancer (defined as clinical, histological, or radiological evidence of metastatic cancer, or receiving anti-cancer therapy with palliative intent). Patients were invited to a baseline assessment, with follow-up assessments at six and twelve weeks. Demographic details and measurements of height, weight and body mass index were collected. Body composition was measured using bioimpedance analysis and (if available) analysis of CT images from routine oncology follow up. Physical function was measured objectively using the Karnofsky Performance Status Scale (KPS) and subjectively using the European Organisation for the Research and Treatment of Cancer – Quality of Life Questionnaire –C30 (EORTC QLQ-C30). The EORTC-QLQ-C30 was also used to gather information regarding symptoms and quality of life. The Functional Assessment of Anorexia/ Cachexia Therapy Scale (FAACT) was included to capture information regarding symptoms related to cachexia. To collect data regarding nutrition and physical function the Patient Generated Subjective Global Assessment – Short Form (PGSGA-SF) was included. Blood samples were analysed for simple markers of the systemic inflammatory response and concentrations of multiple pro- and anti-inflammatory cytokines (e.g., Interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-10, IL-17, and Tissue Necrosis Factor-α). RESULTS: Systematic Reviews: IL‐6, TNF‐α, and IL‐8 levels were greater in cachectic patients than in healthy individuals. Several symptoms of incurable cancer were associated with elevated levels of circulating cytokines i.e., depression, fatigue, and appetite loss were all linked with increased levels of IL-6. These results support the suggestion of a role for inflammatory cytokines in symptom generation, however it is difficult to draw further conclusions due to limitations in study methodology. The definition of cachexia and weight loss thresholds adopted across the studies included were highly variable, as were the methods described for cytokine analysis and the instruments used for assessment of symptoms. REVOLUTION Study: Between July 2020 and June 2021 45 patients were recruited to the REVOLUTION study. Mean age was 65 years, (range 39-91). The majority had a KPS score of 50- 70% (50%- requiring help often, requiring frequent medical care, 70% cares for self, unable to do normal activity or to do active work). The most common primary sites of cancer in the population were breast and colorectal cancer. Thirteen patients participated in assessments at time point two, seven patients participated in assessments at time point three. The most common reason for non-completion was death. Cachexia was not a pre-requisite for recruitment to the study however at baseline 60% of patients were cachectic using a 5% weight loss threshold. In keeping with this finding, the FAACT and PGSGA-SF mean questionnaire scores revealed a high level of nutritional impact symptoms and a significant need for intervention. At baseline using the EORTC-QLQ-C30, patients had a low overall global health status mean score (37.6/100). In terms of cytokine analysis GDF-15 (r=0.511, p=0.004) and IL-1ra (r=0.492, p=0.002) had a significant relationship with BMI. There was a strong correlation between IL-6 levels and constipation (r=0.663, p=<0.01) and a moderate correlation between IL-8 levels and nausea and vomiting (r=0.486, p=0.002) and between TNF-α and diarrhoea (r=0.409, p=0.34). The study adopted a patient-centred approach in order to optimise patient involvement, however this made it more challenging to obtain consistent standardised measurements. CONCLUSION: Results of the systematic reviews suggest links between the systemic inflammatory response, cancer cachexia and the symptoms of incurable cancer. As inflammatory signalling patterns are dynamic, involving cytokines with myriad functions, a standardised longitudinal approach to further research is likely to be required to disentangle these complex relationships. The findings of the REVOLUTION study reinforce the idea that cancer cachexia extends beyond mere weight loss, involving factors such as inflammation, nutritional status, and muscle wasting. The study's exploration of cytokines, such as GDF-15 and IL-1ra, revealed potential links to BMI and suggested these biomarkers could be crucial in understanding cancer cachexia. In an exploration of the symptoms of incurable cancer it was found that nutritional impact symptoms were common and had links with higher levels of inflammatory cytokines such as IL-6, IL-8 and TNF-α. This study provides a foundation for further research to understand the lived experience of incurable cancer and cancer cachexia"],"dc:identifier.uri":["https://hdl.handle.net/1842/43506","http://dx.doi.org/10.7488/era/6042"],"dc:language.iso":["en"],"dc:publisher":["The University of Edinburgh"],"dc:subject":["Systemic Inflammatory Response","Cachexia","Cytokines","Incurable Cancer","REVOLUTION Study"],"dc:title":["Role of the systemic inflammatory response in the clinical and biological features of incurable cancer and cachexia"],"dc:type":["Thesis or Dissertation"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["PhD Doctor of Philosophy"]},"updated_at":"2026-07-24T02:13:55Z"}