6, p = 0.006). In univariate analysis, gender, taking cardioactive medication and having a diagnosis of diabetes mellitus were not associated with binary AFT classification (χ2 = 0.17,

p = 0.7, χ2 = 0.89, p = 0.4 and χ2 = 0.4, p = 0.5 respectively), whereas having at least one cardiovascular comorbidity was associated with having definite/severe AD (χ2 = 3.79, p = 0.05). Having definite/severe Inhibitors,research,lifescience,medical AD was associated with severity of tiredness as measured using the ESAS (median 4/10 versus 2/10, p = 0.006), but not with severity of appetite loss (median 3/10 versus 1/10, p = 0.07) or nausea (median 0/10 versus 0/10, p = 0.9). Age, PPS, taking cardioactive medications, severity of tiredness (ESAS) and severity of appetite loss (ESAS) were entered into the logistic regression models. However, only age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and severity Inhibitors,research,lifescience,medical of tiredness (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were shown to be significantly associated with a diagnosis of definite or severe autonomic dysfunction. Figure 1 Pie chart to show prevalence of autonomic dysfunction Inhibitors,research,lifescience,medical in patients with advanced cancer (n = 91). Table 3 Binary AFT classification according to age (quartiles) The median survival for participants with definite/severe AD was 106 days (95%

CI; 78.6-133.4) compared with 135 days (95% CI; 24.8-245.2) in those with normal/early/atypical classification (χ2 = 4.8, p = 0.028). See Figure ​Figure2.2. The relationship between AD and survival persisted in analysis adjusted for age, defined by quartiles as above (χ2 = 4.3, p = 0.038). Figure 2 Kaplan-Meier plot to show relationship Inhibitors,research,lifescience,medical between survival and autonomic function (n = 138). Eighty-four of the 143 participants (58.7%) who had valid active stand BP data had a systolic BP drop of at Inhibitors,research,lifescience,medical least 30 mmHg on standing. Discussion Using

Ewing’s classification it was possible to diagnose the presence or absence of definite or severe AD in 138/185 (74.6%) first participants, of whom 80% had definite/severe AD. This finding is consistent with the prevalence of moderate/severe AD measured in patients with advanced cancer (n = 50), as reported by Walsh and Nelson, and in men with advanced cancer (n = 48), as reported by Strasser et al of 82% and 81%, respectively [7,9]. In our study, severity of fatigue was BI 2536 mouse greater in patients with definite/severe AD, and although ESAS scores for loss of appetite were greater in those with definite/severe AD, this did not reach statistical significance. Median ESAS scores for nausea were zero in both groups, which most likely reflects the availability of effective treatment for this symptom. Having definite/severe AD was associated with shorter survival.