Research in context
Evidence before this study
Evidence from other studies of patients with cancer suggests that self-reported health status parameters, such as symptoms or functional limitations, could provide independent prognostic information for survival. However, data come mainly from secondary analysis of randomised controlled trials of solid tumours. This issue has not been investigated with hypothesis-driven prospective studies in patients with myelodysplastic syndromes.
We searched PubMed for full-length articles at the time of protocol writing using the following keywords: “myelodysplastic”, “myelodysplasia” AND “fatigue” or “quality of life” or “health status” AND survival AND prognosis. We found no reports investigating the prognostic value of fatigue for overall survival in patients with myelodysplastic syndromes. After completion of our study, we repeated the search on PubMed using the same searching strategy for studies published up to April, 2015; 101 records were retrieved. We found one prospective study investigating the prognostic value of self-reported fatigue in a mixed sample of acute myeloid leukaemia and myelodysplastic syndromes. Although this study provided important insights on this topic, the prognostic value of fatigue was not tested against validated prognostic indices for myelodysplastic syndromes.
Added value of this study
Self-reported pretreatment fatigue severity provided independent prognostic information for survival in patients with higher-risk myelodysplastic syndromes beyond gold-standard prognostic indices, including the International Prognostic Scoring System (IPSS) classification, the WHO-based prognostic scoring system, and the revised version of the IPSS classification.
Implications of all the available evidence
Physicians should assess pretreatment fatigue severity during the initial diagnostic investigation because it provides independent prognostic information for survival. Our findings lay the groundwork for the future elaboration of a patient-centred prognostic index in patients with higher-risk myelodysplastic syndromes that would enable more accurate stratification of patients into different risk groups based on self-reported fatigue.