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. 2015 Aug;50(2):163-75.
doi: 10.1016/j.jpainsymman.2015.02.015. Epub 2015 Mar 28.

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Fay Wright  1 , Gail D'Eramo Melkus  1 , Marilyn Hammer  1 , Brian L Schmidt  2 , M Tish Knobf  3 , Steven M Paul  4 , Frances Cartwright  5 , Judy Mastick  4 , Bruce A Cooper  4 , Lee-May Chen  6 , Michelle Melisko  7 , Jon D Levine  8 , Kord Kober  4 , Bradley E Aouizerat  9 , Christine Miaskowski  10
Affiliations

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Fay Wright et al. J Pain Symptom Manage. 2015 Aug.

Abstract

Context: Fatigue is a distressing persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. Although significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy.

Objectives: To determine whether demographic, clinical, and symptom characteristics were associated with initial levels and the trajectories of evening fatigue.

Methods: A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives.

Results: A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were white, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, childcare responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment.

Conclusion: This study identified both nonmodifiable (e.g., ethnicity) and modifiable (e.g., childcare responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Keywords: Evening fatigue; breast cancer; chemotherapy; diurnal variations; gastrointestinal cancer; gynecological cancer; hierarchical linear modeling; lung cancer; symptom patterns; symptom trajectories.

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Figures

Fig. 1
Fig. 1
Fig. 1A. Piecewise model of mean evening fatigue scores for six assessment points over two cycles of chemotherapy (CTX). Fig. 1B. Spaghetti plots of individual evening fatigue trajectories for a random sample of 30% of the total sample (n=175) over two cycles of CTX. LFAP = Lee Fatigue Scale Evening severity score.
Fig. 2
Fig. 2
Figs. 2A–E. The adjusted change curves for evening fatigue that were estimated based on differences in ethnicity (i.e., ethnicity identified as White or non-White), education (i.e., less education/more education calculated as one standard deviation (SD) above and below the mean), having children at home (i.e., yes or no), functional status (i.e., lower Karnofsky Performance Status (KPS) score/higher KPS score calculated as one SD above and below the mean KPS score), and cancer diagnosis (breast, GYN, or lung cancer versus GI).
Fig. 3
Fig. 3
Figs. 3A–C. Figs. 3A and 3B display the adjusted change curves for evening fatigue that were estimated based on the differences in depressive symptoms (lower Center for Epidemiological Studies-Depression (CES-D) score/higher CES-D score calculated as one standard deviation (SD) above and below the mean CES-D score) and sleep disturbances (lower General Sleep Disturbance Scale (GSDS) score/higher GSDS calculated as one SD above and below the mean GSDS score). In Fig. 3C, the modest effects of the evening fatigue score at enrollment (lower fatigue/higher fatigue calculated as one SD above the mean evening Lee Fatigue Scale score) are plotted.
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References

    1. Esther Kim JE, Dodd MJ, Aouizerat BE, Jahan T, Miaskowski C. A review of the prevalence and impact of multiple symptoms in oncology patients. J Pain Symptom Manage. 2009;37:715–736. - PMC - PubMed
    1. Storey DJ, Waters RA, Hibberd CJ, et al. Clinically relevant fatigue in cancer outpatients: the Edinburgh Cancer Centre symptom study. Ann Oncol. 2007;18:1861–1869. - PubMed
    1. Borneman T, Piper BF, Koczywas M, et al. A qualitative analysis of cancer-related fatigue in ambulatory oncology. Clin J Oncol Nurs. 2012;16:E26–32. - PMC - PubMed
    1. Miaskowski C, Cooper BA, Paul SM, et al. Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: a cluster analysis. Oncol Nurs Forum. 2006;33:E79–89. - PubMed
    1. Barsevick A, Frost M, Zwinderman A, Hall P, Halyard M. I’m so tired: biological and genetic mechanisms of cancer-related fatigue. Qual Life Res. 2010;19:1419–1427. - PMC - PubMed

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