Association of baseline self-reported fatigue with overall survival after stereotactic body radiation therapy for localized prostate cancer

Rishabh K Simhal; Tamir N Sholklapper; Anish K Simhal; Alan L Zwart; Malika T Danner; Deepak Kumar; Nima Aghdam; Simeng Suy; Ryan A Hankins; Keith J Kowalczyk; Sean P Collins

doi:10.3389/fonc.2022.1015264

Association of baseline self-reported fatigue with overall survival after stereotactic body radiation therapy for localized prostate cancer

Front Oncol. 2022 Dec 23:12:1015264. doi: 10.3389/fonc.2022.1015264. eCollection 2022.

Authors

Rishabh K Simhal¹, Tamir N Sholklapper¹, Anish K Simhal², Alan L Zwart³, Malika T Danner³, Deepak Kumar⁴, Nima Aghdam⁵, Simeng Suy³, Ryan A Hankins^{1

6}, Keith J Kowalczyk^{1

6}, Sean P Collins^{1

3}

Affiliations

¹ School of Medicine, Georgetown University, Washington, DC, United States.
² Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
³ Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States.
⁴ Julius L. Chambers Research Institute, North Carolina Central University, Durham, NC, United States.
⁵ Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
⁶ Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States.

Abstract

Introduction: Stereotactic Body Radiation Therapy (SBRT) has emerged as a definitive therapy for localized prostate cancer (PCa). However, more data is needed to predict patient prognosis to help guide which patients will benefit most from treatment. The FACIT-Fatigue (FACIT-F) is a well validated, widely used survey for assessing fatigue. However, the role of fatigue in predicting PCa survival has yet to be studied. Herein, we investigate the role of FACIT-F as a baseline predictor for overall survival (OS) in patients undergoing SBRT for localized PCa.

Methods: A retrospective review was conducted of 1358 patients who received SBRT monotherapy between January 2008 to April 2021 at an academic, tertiary referral center. FACIT-F scores (range 0 to 52) were summed for patients who answered all 13-items on the survey. FACIT-F total scores of ≥35 represented severe fatigue. Patients receiving androgen deprivation therapy were excluded. Differences in fatigue groups were evaluated using chi-squared tests. OS rates were determined using the Kaplan-Meier method and predictors of OS were evaluated using Cox proportional hazard method.

Results: Baseline full FACIT-F scores and survival data was available for 891 patients. 5-year OS was 87.6% and 95.2%, respectively, for the severely fatigued and non-fatigued groups. Chi-squared analysis of fatigue groups showed no significant difference in the following categories: D'Amico risk group, age, ethnicity, grade group, T-stage, or PSA density. Severe fatigue was associated with a significant decrease in OS (hazard ratio 2.76; 95%CI 1.55 - 4.89). The Cox proportional hazard model revealed that age and FACIT-F were both statistically significant (p <0.05).

Conclusion: Baseline FACIT-F scores are significantly associated with OS. Higher FACIT-F scores, representing less fatigued patients, are associated with an overall survival benefit. These results indicate that the FACIT-F survey could serve as an additional metric for clinicians in determining prognostic factors for patients undergoing SBRT.

Keywords: SBRT (stereotactic body radiation therapy); baseline fatigue; localized prostate cancer (PCa); overall survival; prostate cancer; prostate radiation therapy; quality of life; urology.

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States