Chronic inflammation increases the risk for cancer, contributes to adverse events during cancer therapies, and impacts treatment outcomes, and the immune system plays an integral on the cancer microenvironment. Lifestyle factors and the environment contribute to chronic inflammation, and nurses can play an important role in helping patients live a healthier life.
Table 1. Acute Versus Chronic Inflammation Responses
| Acute Inflammation | Chronic Inflammation | |
| Trigger |
|
|
| Onset | Immediate | Insidious |
| Duration | Days to weeks | Months to years |
| Mediator response | Normal cytokine signaling response | Constitutive overexpression of pro-inflammatory cytokines, chemokines, prostaglandins |
| Cellular response | Innate immune response (e.g., neutrophils, macrophages) | Adaptive immune response (e.g., lymphocytes, B-cell, plasma cells, fibroblasts) |
| Outcome | With a healthy immune system, a complete resolution | Can lead to chronic conditions, including
|
Raymond DuBois, MD, PhD, adjunct professor, Arizona State University School of Molecular Sciences, Tempe, AZ, and Marilyn Hammer, PhD, DC, RN, an assistant professor at New York University, discussed inflammation-related outcomes during a session jointly presented by the American Association for Cancer Research and ONS.
Hammer began by explaining the difference between acute and chronic inflammation: acute inflammation is a healthy immune response to tissue damage or microbial invasion that is time-limited, whereas chronic inflammation leads to an eventual loss of immune function because of the longterm effects (TABLE 1).
Chronic inflammation can cause structural damage to immune cells and limit the immune system’s ability to detect and eliminate foreign micro-organisms. This leads to an interference with mechanisms that normally detect and arrest aberrant cell growth. Chronic inflammation can lead to an increased risk for adverse events, including infections, organ dysfunction, and death; promotion of malignancy formulation and proliferation; and risk for symptoms such as pain, fatigue, depression, and sleep disturbances. It can also lead to tumor growth and has been linked specifically to colorectal, bladder, esophageal, gastrointestinal, ovarian epithelium, and pancreatic cancers.
Chronic inflammation can result from infectious agents, cigarette smoking, exposure to asbestos and silica, imbalances (e.g., high-fat, high-sugar, processed foods diet), and stress. A number of viruses are also linked to cancer, including
- Human papilloma virus à Cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers
- Hepatitis B virus à Liver cancer
- Human T-cell leukemia virus 1 -> Adult T-cell leukemia
- Human T-cell leukemia virus 2 -> Hairy-cell leukemia
- Epstein-Barr virus à Burkitt lymphoma, lymphoma, Hodgkin disease
- Human herpes virus à Kaposi sarcoma.
Environmental and lifestyle choices are also known contributors to inflammation and cancer, including a poor diet and environmental hazards.
Hammer said that as oncology nurses, the responsibility is “not just keeping our patients alive, but keeping our patients in life.” As oncology nurses, “we can do things on a large and small scale,” to promote healthy living for patients, Hammer said, specifically noting
- Promoting anti-inflammatory nutrients
- Mediterranean diet (including fish oil, fresh fruits and vegetables, lean proteins, whole grains, and walnuts)
- Curcumin (a potent anti-inflammatory ingredient in turmeric)
- Promoting physical activity
- Encouraging and guiding patients in smoking cessation
- Providing stress relief/control tactics.
Immunotherapy and microbiome research are also leading the way in combatting cancer and inflammation. Monoclonal antibodies, vaccines, and immune checkpoint inhibitors, for example, use the immune system to recognize and arrest cancerous cell formation.
DuBois concluded the session by noting that the burden of inflammation goes beyond cancer, reaching diabetes, Alzheimer disease, and cardiovascular diseases. The cause for death in the U.S. population has changed since 1900, when infection-related causes were most prevalent. Today, 63% of the current causes of death are because of heart disease, which DuBois noted is “a huge burden on our health system.” While heart disease is the leading cause of death, the prevalence of the disease has actually decreased since the advent of statins, while cancer rates have remained more stagnant, only recently declining. “As the Baby Boomer [generation] ages out and gets older, this is going to become a bigger problem for our health system. One I do not think we are prepared for,” DuBois concluded.