Analysis of overall survival and self-reported fatigue in patients with locally advanced esophageal cancer: A Mayo Clinic Esophageal Adenocarcinoma and Barrett’s Esophagus Registry Consortium study.

Abstract

9057 Background: We analyzed overall survival (OS) and self-reported fatigue scores in patients with esophageal cancer (EC) enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett’s Esophagus Registry (EABE). Methods: Patients enrolled in the EABE between September 2001 and January 2009 returned a baseline quality of life questionnaire (n=1,481) including a Linear Analog Self Assessment (LASA) fatigue score which was scored on a 0-10 scale, with 0 as the most extreme fatigue. Patients were categorized as having a clinically deficient fatigue (DF) level if they reported a score of ≤ 5 and a clinically non-deficient fatigue (nDF) level if they reported a score of >5. Kaplan-Meier methodology and Cox models explored the relationship between OS and fatigue scores in patients with EC. Results: A total of 667 patients with EC were included in the EABE, of which 659 returned a registry questionnaire with a valid LASA fatigue score recorded. Median age at the time of registry entry was 65 years (range 23-92). A total of 392 (59%) and 267 patients (41%) reported DF and nDF, respectively. On univariate analysis, patients with nDF had improved 5-year OS compared to patients with DF. In patients having esophagectomy prior to LASA, those reporting nDF had improved survival compared to patients with DF (54% vs 40%, HR=0.63, p=0.04). A similar result was seen in patients having no esophagectomy prior to LASA (28% vs 20%, HR=0.75, p=0.03). Among the 368 patients with locally advanced EC (LAEC), those reporting nDF had improved 5-year OS compared to patients with DF. This remained significant on multivariate analysis (HR=0.71, p=.015). Conclusions: Patient-reported fatigue is associated with overall survival in patients with esophageal cancer, including those with LAEC. Therefore, fatigue scores should be considered as a stratification factor in the design of future clinical trials. N (events) 5-year OS P value HR (95% CI) All EC patients DF nDF 392 (218) 267 (126) 28% (22% - 35%) 37% (30% - 46%) .006 0.74 (0.59 – 0.92) Locally advanced EC DF nDF 216 (144) 152 (84) 17% (11% - 26%) 28% (19% - 40%) .003 0.67 (0.51 – 0.87)