Self-Reported Fatigue Provides Independent Prognostic Information in Patients With Myelodysplastic Syndromes
In a prospective observational cohort study reported in The Lancet Oncology, Efficace et al found that a self-reported fatigue score provides independent prognostic information on overall survival in patients with higher-risk myelodysplastic syndromes. Fatigue assessment should be included in routine diagnostic workups and as a stratification factor in future clinical trials in this setting, they urged.
Study Details
The study included 280 adult patients consecutively enrolled between November 2008 and August 2012 from 37 centers in Europe, the United States, and east Asia. Patients were enrolled within 6 months of diagnosis and had to have an International Prognostic Scoring System (IPSS) intermediate-2–risk (n = 206) or high-risk score (n = 74); they were enrolled irrespective of older age, comorbidities, performance status, or progression from a lower IPSS risk score.
Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire–Core 30; fatigue scores ranged from 0 (lowest fatigue) to 100. The primary endpoint was overall survival by baseline self-reported fatigue ratings.
Fatigue a Prognostic Factor
Patients had a median age of 71 years, and median follow-up was 15 months. Median overall survival from diagnosis was 17 months.
In univariate analysis, factors significantly associated with reduced overall survival were increasing age (hazard ratio [HR] = 1.022, P = .0071, per 1-year increase), transfusion dependency (receipt of at least one red blood cell transfusion every 8 weeks over 4 months; HR = 1.489, P = .0329), Eastern Cooperative Oncology Group performance status of ≥ 2 (HR = 1.719, P = .0017), increased white blood cell count (HR = 1.023, P = .028), high-risk IPSS score (HR = 3.178, P = .0002, vs intermediate-2–risk score), and higher self-reported fatigue severity (HR = 1.130, P < .0001, for every 10-point increase).
In multivariate analysis, factors independently associated with reduced overall survival were high-risk IPSS score (HR = 2.525, P = .0035, vs intermediate-2–risk score) and higher fatigue score (HR = 1.110, P = .0007, for every 10-point increase). Fatigue was also an independent factor in additional multivariate models including the World Health Organization–based prognostic scoring system (HR = 1.120, P = .0003) and revised IPSS classification system (HR = 1.130, P = .0002).
The investigators concluded: “In patients with newly diagnosed higher-risk myelodysplastic syndromes, self-reported fatigue severity provides prognostic information for survival independent from gold-standard risk classifications. Our findings suggest that fatigue assessment should be included in routine diagnostic investigation for these patients and considered as a standard baseline stratification factor in future randomised controlled trials.”
The study was funded by the Associazione Italiana contro le Leucemie, Linfomi e Mieloma.
Fabio Efficace, PhD, of the Italian Group for Adult Hematologic Diseases (GIMEMA), is the corresponding author of The Lancet Oncology article.
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