Clinically significant fatigue (CSF) at the start of treatment for advanced hormone-refractory prostate cancer (HRPC) or advanced non-small cell lung cancer (NSCLC) demonstrated prognostic value, according to a new analysis published in JCO Oncology Practice.1

The analysis was based on data obtained through the SWOG Cancer Research Network involving 4 prospective phase 2 or 3 clinical trials with chemotherapy for advanced HRPC or advanced NSCLC. The main outcome of the analysis was survival, and this was evaluated with consideration of whether baseline CSF was present. CSF was established based on scores relevant to fatigue obtained from quality-of-life (QOL) questionnaires.

A total of 1907 participants were included who had complete baseline QOL information. Baseline CSF was reported in slightly more than half (52%) of the included patients. The median age of included patients was 69 years (range, 32-91) at registration.

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In both studies of HRPC, higher mortality rates were seen with baseline CSF. Adjusted hazard ratios (HRs) for mortality with baseline CSF were 1.32 (95% CI, 1.13-1.55; P <.001) and 1.31 (95% CI, 1.02-1.67; P =.03) in the HRPC studies. Median survival times were 16 months with baseline CSF versus 24 months without baseline CSF in one of the HRPC studies (P <.001). These times were 14 months and 19 months, respectively, in the other HRPC study (P <.001).

In one of the 2 NSCLC studies, a significant association was seen between higher mortality and baseline CSF (HR, 1.44; 95% CI, 1.04-2.00; P =.03) in a Cox regression analysis. For the other NSCLC study, the result was not statistically significant (HR, 1.53; 95% CI, 0.95-2.45; P =.08). Median survival times with NSCLC were 6 months with baseline CSF, versus 11 months without baseline CSF, in one study (P =.01). In the other study they were 7 months with baseline CSF versus 12 months without it (P =.004).

In the HRPC studies, some adverse events (AEs) of grades 3 to 5 also showed greater incidence with baseline CSF, such as constitutional and neurologic AEs. Statistically significant differences in AEs of grades 3 to 5 based on baseline CSF were not seen in patients with NSCLC.

“Our data suggest that among study participants with baseline CSF receiving chemotherapy, clinicians should more vigorously follow them for the development of AEs,” the authors of the analysis concluded in their report.


Mo J, Darke AK, Guthrie KA, et al. Association of fatigue and outcomes in advanced cancer: an analysis of four SWOG treatment trials. JCO Oncol Pract. 2021;17(8):e1246-e1257. doi:10.1200/OP.20.01096