Oct 1 2015
By Shreeya Nanda, Senior medwireNews Reporter
Patient-reported fatigue severity is an independent prognostic marker for survival in patients with newly diagnosed intermediate-2- or high-risk myelodysplastic syndromes, according to research published in The Lancet Oncology.
“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”, write the researchers.
A total of 280 participants diagnosed with myelodysplastic syndromes in the 6 months prior to enrolment completed the EORTC quality of life questionnaire-core 30 before receiving treatment for their intermediate-2- or high-risk disease, as assessed by the gold standard International Prognostic Scoring System (IPSS). The EORTC questionnaire has three questions on fatigue, the raw scores of which are transformed into a scale ranging from 0 to 100, with higher scores indicating worse fatigue.
Various baseline patient, disease and clinical variables – such as increasing age and elevated white blood cell count – were significantly associated with shorter survival in univariate analysis. But in multivariate analysis, only higher self-reported fatigue and a high-risk IPSS score remained significant predictors of survival, with hazard ratios (HRs) of 1.110 for every 10-point worsening of fatigue and 2.525, respectively.
Higher fatigue severity continued to be significantly associated with survival in multivariate models including either the WHO-based prognostic scoring system or the revised version of the IPSS, with respective HRs of 1.120 and 1.130.
During a median follow-up of 15 months, median overall survival for the whole cohort was 17 months. But when patients were stratified by fatigue score, those with a score equal to or over the median of 34 on the fatigue scale had a significantly shorter overall survival than those with a lower score, at a median of 14 versus 19 months (HR=1.622).
And the likelihood of mortality within the first year of reporting was higher for participants with the highest possible score on the fatigue scale than for those with the lowest possible, with a significant HR of 3.742.
Researcher Fabio Efficace (Data Center and Health Outcomes Research Unit, Rome, Italy) and team comment: “Our data might suggest that patients themselves are accurate judges of their own health status and that this assessment might show an early indicator of disease progression that cannot be inferred by use of standard clinical and instrumental diagnostic procedures.”
However, they did not delve into the reasons underlying the association, which commentator Carolyn Gotay (University of British Columbia, Vancouver, Canada) finds “disappointing”.
She writes in an accompanying piece that the authors might have included a few additional variables – such as mental health status, physical activity and nutrition – in their “high-quality dataset” in a bid to further understand the relationship.
Gotay adds that it is important “to ascertain whether treating fatigue can translate into patient benefit, including mitigation of this symptom and even possibly extending lifespan.”
The commentator concludes: “The time has come to go beyond documenting the prognostic relationship between patient-reported outcomes and survival to exploring how this knowledge can be used for patient benefit.”
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