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Overall survival and self-reported fatigue in patients with esophageal cancer

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Abstract

Purpose

A prospective cohort study was conducted to analyze whether self-reported fatigue predicts overall survival in patients with esophageal cancer.

Methods

Patients enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry between September 2001 and January 2009 who completed a baseline quality of life instrument were eligible for evaluation. The fatigue component was scored on a 0–10 scale, with 0 as extreme fatigue. Patients were categorized as having a decreased energy level if they reported a score of ≤5. Fatigue scores ≥6 reflect normal levels of energy.

Results

Data from a total of 659 enrolled patients were analyzed. A total of 392 (59 %) and 267 (41 %) patients reported decreased and normal energy, respectively. Univariate analysis indicates patients with normal energy had improved 5-year survival compared to patients with decreased energy (37 vs 28 %, hazard ratio (HR) 0.74, p = 0.006). Among the patients with locally advanced disease, the same relationship was seen (28 vs 17 %, HR = 0.67, p = 0.003); this remained significant on multivariate analysis (HR = 0.71, p = 0.015).

Conclusions

A decreased energy level is associated with poor survival in patients with esophageal cancer. Thus, patients with high levels of fatigue should be referred for psychological support and be considered for therapy aimed at amelioration of fatigue symptoms.

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Abbreviations

AJCC:

American Joint Committee on Cancer

ANC:

Absolute neutrophil count

cdQOL:

Clinically deficient quality of life

CI:

Confidence interval

DE:

Decreased energy

EABE:

Esophageal Adenocarcinoma and Barrett's Esophagus Registry Consortium

EC:

Esophageal cancer

EORTC:

European Organization for Research and Treatment of Cancer

HR:

Hazard ratio

hrQOL:

Health-related quality of life

LASA:

Linear Analog Self-Assessment

NE:

Normal energy

OS:

Overall survival

QLC-C30:

Quality of Life Questionnaire-Core 30

QOL:

Quality of life

TNM:

Tumor node metastasis

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Acknowledgments

This project was supported in part by Public Health Service grants CA 25224 and CA 37404 the American Digestive Health Foundation “Endoscopic Research Award,” the American College of Gastroenterology “Junior Faculty Development Award,” the Glaxo Wellcome Inc. Institute for Digestive Health “Clinical Research Award,” and the Miles and Shirley Fiterman Center for Digestive Diseases at Mayo Clinic, Rochester, MN. Additional funding was provided by ACOSOG grant CA149950. Yvonne Romero, MD was supported in part by a grant from the National Institutes of Health (NIDDK 02956) and the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program. The authors would like to recognize the members of the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry Consortium who have contributed to data collection and concept design. A list of all members of the Consortium can be found in the Electronic supplementary material.

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    M. C. Stauder, M. Botros & R. C. Miller

  2. Division of Gastroenterology & Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Y. Romero, D. Geno & A. S. Arora

  3. Department of Otolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Y. Romero

  4. Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    B. Kabat, P. J. Atherton & J. A. Sloan

  5. Division of General Thoracic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    C. Deschamps

  6. Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    A. Jatoi

  7. Department of Internal Medicine, Asan Medical Center, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, South Korea

    K. W. Jung

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  1. M. C. Stauder
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Correspondence to M. C. Stauder.

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Stauder, M.C., Romero, Y., Kabat, B. et al. Overall survival and self-reported fatigue in patients with esophageal cancer. Support Care Cancer 21, 511–519 (2013). https://doi.org/10.1007/s00520-012-1537-1

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