Contributions
Abstract: S148
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:30 - 12:45
Location: Room A10
Background
Hematological malignancies represent typical diseases at advanced age. The relevance of the patient-reported outcome (PRO) fatigue in decision making and as an endpoint in clinical studies in older persons has been propagated recently. However, prospective data on the distribution and clinical impact on fatigue in elderly patients with a hematological malignancy are rare.
Aims
We set out to determine the prevalence and the association of self-reported fatigue with clinical outcome and geriatric impairments in older individuals newly diagnosed with blood cancer.
Methods
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) newly diagnosed with a hematologic malignancy at Innsbruck University Hospital between January 2009 and April 2016.
Results
Self-reported fatigue as defined by EORTC QLQ-C30 was the most prevalent symptom (84 %). Other symptoms namely insomnia, dyspnea, loss of appetite, pain and constipation were reported by about a half to a quarter of patients. Moreover, functional impairments, namely in physical, role and emotional functioning, were observed in a relevant proportion of patients. Increased fatigue was significantly associated with reduced self-reported role, physical functioning as well as global health status as defined by EORTC QLQ-C30. 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 markers of inflammation (p < 0.001). Patients with minor fatigue had a median overall survival of 26.4 months, whereas those with marked fatigue had a median OS of 7.0 months (p < 0.001). The association of fatigue with shortened OS was supported in multivariate analyses (hazard ratio 1.74, CI 1.09 – 2.76; p=0.021).
Conclusion
Fatigue reveals a high prevalence and represents an adverse prognostic factor in elderly patients with a hematological malignancy. The strong impact of fatigue on clinical performance and overall survival emphasizes the relevance of patient reported outcomes for individualized treatment algorithms. Patients will particularly benefit from early identification of fatigue, allowing for timely interventions. The correlation of fatigue, reduced performance capacities, nutritional status and inflammation might suggest an underlying common pathway.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Fatigue, Hematological malignancy, Quality of Life
Abstract: S148
Type: Oral Presentation
Presentation during EHA23: On Friday, June 15, 2018 from 12:30 - 12:45
Location: Room A10
Background
Hematological malignancies represent typical diseases at advanced age. The relevance of the patient-reported outcome (PRO) fatigue in decision making and as an endpoint in clinical studies in older persons has been propagated recently. However, prospective data on the distribution and clinical impact on fatigue in elderly patients with a hematological malignancy are rare.
Aims
We set out to determine the prevalence and the association of self-reported fatigue with clinical outcome and geriatric impairments in older individuals newly diagnosed with blood cancer.
Methods
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) newly diagnosed with a hematologic malignancy at Innsbruck University Hospital between January 2009 and April 2016.
Results
Self-reported fatigue as defined by EORTC QLQ-C30 was the most prevalent symptom (84 %). Other symptoms namely insomnia, dyspnea, loss of appetite, pain and constipation were reported by about a half to a quarter of patients. Moreover, functional impairments, namely in physical, role and emotional functioning, were observed in a relevant proportion of patients. Increased fatigue was significantly associated with reduced self-reported role, physical functioning as well as global health status as defined by EORTC QLQ-C30. 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 markers of inflammation (p < 0.001). Patients with minor fatigue had a median overall survival of 26.4 months, whereas those with marked fatigue had a median OS of 7.0 months (p < 0.001). The association of fatigue with shortened OS was supported in multivariate analyses (hazard ratio 1.74, CI 1.09 – 2.76; p=0.021).
Conclusion
Fatigue reveals a high prevalence and represents an adverse prognostic factor in elderly patients with a hematological malignancy. The strong impact of fatigue on clinical performance and overall survival emphasizes the relevance of patient reported outcomes for individualized treatment algorithms. Patients will particularly benefit from early identification of fatigue, allowing for timely interventions. The correlation of fatigue, reduced performance capacities, nutritional status and inflammation might suggest an underlying common pathway.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Fatigue, Hematological malignancy, Quality of Life