title: Predicting survival in advanced hematologic malignancies: do patient-reported symptoms matter?
abstract: OBJECTIVE
  To investigate whether patient-reported symptoms provide independent prognostic information for survival in patients with hematological malignancies.
  
  
  METHODS
  Overall 119 patients with various diagnoses were recruited in an observational study and symptoms were assessed with the M.D. Anderson Symptom Inventory (MDASI). Key potential socio-demographic, biomedical, and physician-reported prognostic candidates were also considered. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Additional sensitivity analysis, based on 500 bootstrap-generated simulation datasets, was also performed to confirm the results obtained with the Cox regression model.
  
  
  RESULTS
  The median survival of the entire cohort was 4.8 months (range 0-28 months). The MDASI was completed at baseline by 91% of patients. The final multivariate model retained two parameters as independent prognostic factors for survival: clinical prognostic group and patient's self-reported severity of drowsiness. The following hazard ratios (HR) were found for curable vs. terminal: 0.055 (95% CI, 0.022-0.136; P < 0.001) and 0.193 (95% CI, 0.103-0.362: P < 0.001) for advanced vs. terminal. Patient's self-reported severity of drowsiness independently predicted survival with a HR of 1.801 (95% CI, 1.044-3.107; P = 0.033). Additional sensitivity analysis confirmed the independent prognostic value of variables identified in this study.
  
  
  CONCLUSIONS
  The results suggest that patients' self-reporting of symptoms provides independent prognostic information for survival in patients with hematologic malignancies. These findings underscore the value of collecting patient-reported symptom data in routine clinical practice.
authors.affiliation: Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy. f.efﬁcace@gimema.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Efficace
authors.forename: Claudio
authors.initials: C
authors.lastname: Cartoni
authors.forename: Pasquale
authors.initials: P
authors.lastname: Niscola
authors.forename: Andrea
authors.initials: A
authors.lastname: Tendas
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Meloni
authors.forename: Laura
authors.initials: L
authors.lastname: Scaramucci
authors.forename: Salvatore
authors.initials: S
authors.lastname: Soldati
authors.forename: Gregorio Antonio
authors.initials: GA
authors.lastname: Brunetti
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Marini
authors.forename: Franco
authors.initials: F
authors.lastname: Mandelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010361:Patients; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D057566:Self Report; D063189:Symptom Assessment