title: Overall survival and self-reported fatigue in patients with esophageal cancer.
abstract: OBJECTIVE
  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.
authors: Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. stauder.michael@mayo.edu
authors: M C
authors: MC
authors: Stauder
authors: Y
authors: Y
authors: Romero
authors: B
authors: B
authors: Kabat
authors: P J
authors: PJ
authors: Atherton
authors: D
authors: D
authors: Geno
authors: C
authors: C
authors: Deschamps
authors: A
authors: A
authors: Jatoi
authors: J A
authors: JA
authors: Sloan
authors: M
authors: M
authors: Botros
authors: K W
authors: KW
authors: Jung
authors: A S
authors: AS
authors: Arora
authors: R C
authors: RC
authors: Miller
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000401:mortality / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000473:pathology; D004938:Esophageal Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018434:Sickness Impact Profile; D016019:Survival Analysis; D055815:Young Adult