Association of Fatigue and Outcomes in Advanced Cancer: An Analysis of Four SWOG Treatment Trials

Julia Mo, Amy K. Darke, Katherine A. Guthrie, Jeff A. Sloan, Joseph M. Unger, Dawn L. Hershman, Mark O'Rourke, Marie Bakitas, Robert S. Krouse

Research output: Contribution to journalArticlepeer-review


PURPOSE:Patient-reported outcomes may be associated with cancer outcomes. We evaluated clinically significant fatigue (CSF), overall survival, adverse events (AEs), and quality of life (QOL) during cancer treatment.METHODS:We compared outcomes in four phase II or III chemotherapy trials, two advanced non-small-cell lung cancer and two advanced hormone-refractory prostate cancer, with or without baseline CSF. CSF was defined as a rating of two or greater on the Functional Assessment of Cancer Therapy fatigue question or a European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 fatigue symptom score of 50% or greater. Survival was compared according to CSF using Kaplan-Meier estimates and Cox regression models. Differences in AE rates by CSF were assessed via chi-squared tests, and QOL changes from baseline to 3 months via linear regression.RESULTS:Of 1,994 participants, 1,907 (median age 69 years, range: 32-91) had complete baseline QOL survey data, with 52% reporting CSF at baseline. For the two hormone-refractory prostate cancer studies, baseline CSF was associated with higher mortality rates, with adjusted hazard ratios of (95% CI, P value) 1.32 (1.13 to 1.55, P <.001) and 1.31 (1.02 to 1.67, P =.03) and with increased incidence of grade 3-5 constitutional (16.5% v 9.4%, P =.002; 13.9% v 6.3%, P =.002) and neurologic (11.7% v 6.1%, P =.006; 9.0% v 3.9%, P =.01) AEs, respectively. Baseline CSF was associated with a higher mortality rate in one non-small-cell lung cancer study: hazard ratio 1.44 and 1.04 to 2.00, P =.03.CONCLUSION:Oncology trial participants with baseline CSF had poorer survival and experienced more AEs than participants without CSF. This indicates fatigue as an important baseline prognostic factor in oncology treatment trials.

Original languageEnglish (US)
Pages (from-to)E1246-E1257
JournalJCO Oncology Practice
Issue number8
StatePublished - Aug 1 2021

ASJC Scopus subject areas

  • Oncology
  • Health Policy
  • Oncology(nursing)


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