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. 2017 May;53(5):887-900.e2.
doi: 10.1016/j.jpainsymman.2016.12.339. Epub 2017 Jan 4.

Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy

Hamza Abid  1 , Kord M Kober  1 , Betty Smoot  2 , Steven M Paul  1 , Marilyn Hammer  3 , Jon D Levine  2 , Kathryn Lee  1 , Fay Wright  4 , Bruce A Cooper  1 , Yvette P Conley  5 , Christine Miaskowski  6
Affiliations

Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy

Hamza Abid et al. J Pain Symptom Manage. 2017 May.

Abstract

Context: Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment.

Objectives: The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy.

Methods: Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data.

Results: A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time.

Conclusion: Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.

Keywords: Morning energy; cancer; chemotherapy; diurnal variations; evening energy; hierarchical linear modeling; oncology; symptom trajectories.

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Figures

Figure 1
Figure 1
Figure 1A – Piecewise model of mean morning energy scores for six assessment points over two cycles of chemotherapy (CTX). Figure 1B – Spaghetti plots of individual morning energy trajectories for a random sample of 50 patients over two cycles of CTX. Abbreviation: LENA = Lee Fatigue Scale - Morning Energy subscale score. Figure 1C – Piecewise model of mean evening energy scores for six assessment points over two cycles of chemotherapy (CTX). Figure 1D – Spaghetti plots of individual evening energy trajectories for a random sample of 50 patients over two cycles of CTX. Abbreviation: LENP = Lee Fatigue Scale - Evening Energy subscale score.
Figure 2
Figure 2
A-E- Influence of enrollment scores for living alone (A), child care responsibilities (B), Karnofsky Performance Status (KPS) score (C), exercise (D), and hemoglobin level (E), on inter-individual differences in the intercept for morning energy.
Figure 3
Figure 3
A-E Influence of enrollment scores for trait anxiety (A) and attentional function (B), on inter-individual differences in the intercept for morning energy, and influence of morning energy (C) and body mass index (BMI, D) on the slope parameters for morning energy and influence of enrollment scores for sleep disturbance (E) on inter-individual differences in the intercept and slope parameters for morning energy.
Figure 4
Figure 4
A-F Influence of gender (A), ethnicity (B), and enrollment scores Karnofsky Performance Status (KPS, C), sleep disturbance (D) and attentional function (E) on inter-individual differences in the intercept for evening energy, and influence of evening energy score at enrollment (F) on the slope parameters for evening energy.
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References

    1. Barsevick AM, Whitmer K, Sweeney C, et al. A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nurs. 2002;25:333–341. - PubMed
    1. Barsevick AM, Dudley W, Beck S, et al. A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer. 2004;100:1302–1310. - PubMed
    1. Berger AM, Mooney K, Alvarez-Perez A, et al. Cancer-Related Fatigue, Version 2. 2015. J Natl Compr Canc Netw. 2015;13:1012–1039. - PMC - PubMed
    1. Gay CL, Lee KA, Lee SY. Sleep patterns and fatigue in new mothers and fathers. Biol Res Nurs. 2004;5:311–318. - PMC - PubMed
    1. Lee KA, Gay C, Portillo CJ, et al. Symptom experience in HIV-infected adults: a function of demographic and clinical characteristics. J Pain Symptom Manage. 2009;38:882–893. - PMC - PubMed

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