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. 2018 Nov;97(11):2235-2243.
doi: 10.1007/s00277-018-3420-8. Epub 2018 Jul 28.

Fatigue at baseline is associated with geriatric impairments and represents an adverse prognostic factor in older patients with a hematological malignancy

F Hofer  1 , K A Koinig  1 , L Nagl  1 , B Borjan  1 , R Stauder  2
Affiliations

Fatigue at baseline is associated with geriatric impairments and represents an adverse prognostic factor in older patients with a hematological malignancy

F Hofer et al. Ann Hematol. 2018 Nov.

Abstract

Prospective data on fatigue in elderly persons with a hematological malignancy are rare. We aimed to determine the prevalence of fatigue and its association with clinical outcome and geriatric impairments in older individuals newly diagnosed with blood cancer. The EORTC QLQ-C30 and a multidimensional geriatric assessment (MGA) were performed in parallel in 149 consecutive patients aged > 67 years (median 77.8 years) at Innsbruck Medical University between January 2009 and April 2016. Fatigue as defined by EORTC QLQ-C30 was the most prevalent symptom (84%) and was significantly associated with self-reported role and physical functioning, global health status and insomnia, dyspnea, and loss of appetite (p < 0.001). Remarkably, pronounced fatigue was associated with impaired performance status and objective functional capacities in MGA, with altered depression scoring, G8 screening, and elevation of serum inflammation markers (p < 0.001). Patients with minor fatigue had a median overall survival (OS) of 26.4 months, whereas those with marked fatigue displayed an OS of 7.0 months (p < 0.001). The association between fatigue and shortened OS was supported in multivariate analyses (HR 1.74, CI 1.09-2.76; p = 0.021). Fatigue is seen to have a high prevalence and to be an adverse prognostic factor in elderly patients with a hematological malignancy. The strong impact of fatigue on clinical performance and OS emphasizes the relevance of patient-reported outcomes in individualized treatment algorithms. Patients will benefit from identification of fatigue, allowing timely interventions. The correlation between fatigue, impaired performance, nutritional status, and inflammation might suggest an underlying common pathway.

Keywords: Fatigue; Geriatric assessment; Hematological malignancies; Patient-reported outcomes; Quality of life.

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Conflict of interest statement

Conflict of interest

The authors declare no competing financial interests in relation to this work. Outside the submitted work, R. Stauder received research funding and honoraria from Celgene, Teva and Novartis.

Figures

Fig. 1
Fig. 1
a Prevalence of symptoms as defined by EORTC QLQ-C30. b Prevalence of functional impairments as defined by EORTC QLQ-C30
Fig. 2
Fig. 2
Pronounced fatigue is significantly associated with shortened overall survival at 4 years
See this image and copyright information in PMC

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