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. 2016 Apr;24(4):1473-85.
doi: 10.1007/s00520-015-2895-2. Epub 2015 Sep 11.

Subgroups of chemotherapy patients with distinct morning and evening fatigue trajectories

Kord M Kober  1   2 , Bruce A Cooper  3 , Steven M Paul  3 , Laura B Dunn  4 , Jon D Levine  4 , Fay Wright  5 , Marilyn J Hammer  5 , Judy Mastick  3 , Alan Venook  4 , Bradley E Aouizerat  3   6 , Christine Miaskowski  3
Affiliations

Subgroups of chemotherapy patients with distinct morning and evening fatigue trajectories

Kord M Kober et al. Support Care Cancer. 2016 Apr.

Abstract

Purpose: Purposes of this study were to identify subgroups of patients with distinct trajectories for morning and evening fatigue, evaluate for differences in demographic and clinical characteristics among these subgroups, and compare and contrast the predictors of subgroup membership for morning and evening fatigue.

Methods: Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n = 582) completed questionnaires, a total of six times over two cycles of chemotherapy (CTX). Morning and evening fatigue severity were evaluated using the Lee Fatigue Scale. Latent profile analysis (LPA) was used to identify distinct subgroups.

Results: Three latent classes were identified for morning fatigue (i.e., low (31.8 %), high (51.4 %), and very high (16.8 %)) and for evening fatigue (i.e., moderate (20.0 %), high (21.8 %), and very high (58.2 %)). Most of the disease and treatment characteristics did not distinguish among the morning and evening fatigue classes. Compared to the low class, patients in the high and very high morning fatigue classes were younger, had a lower functional status, and higher level of comorbidity. Compared to the moderate class, patients in the very high evening fatigue class were younger, more likely to be female, had child care responsibilities, had a lower functional status, and a higher level of comorbidity.

Conclusion: LPA allows for the identification of risk factors for more severe fatigue. Since an overlap was not observed across the morning and evening fatigue classes and unique predictors for morning and evening fatigue were identified, these findings suggest that morning and evening fatigue may have distinct underlying mechanisms.

Keywords: Cancer; Chemotherapy; Diurnal variations; Evening fatigue; Fatigue; Latent class analysis; Latent profile analysis; Morning fatigue.

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Figures

Figure 1
Figure 1
Trajectories of morning and evening fatigue in the latent classes
Figure 2
Figure 2
Overlap in membership among the morning and evening classes. Black circles represent the number (n) and percentage of all patients (a) in the intersecting Morning and Evening Fatigue classes. Percentages of patients found in the Morning Fatigue classes (row totals) and the three Evening Fatigue classes are given by (b). Percentages of patients found in the Evening Fatigue classes (column totals) by the three Morning Fatigue classes are given by (c). Of the 582 patients enrolled in this study, 15.1% (n=88) were classified in both the Very High Morning and Very High Evening fatigue classes. Of those patients in the Very High Morning Fatigue class (n=98), 89.8% (n=88) were also in Very High Evening Fatigue class. In contrast, of those patients in the Very High Evening Fatigue class (n=339), only 26.0% (n=88) of them were in the Very High Morning Fatigue class. Eighty-four patients (14.4%) were classified in both the High Morning and High Evening Fatigue latent classes. Of those patients in the High Morning Fatigue class (n=297), 28.1% (n=84) of them were in the High Evening Fatigue class. In contrast, of those patients in the High Evening Fatigue class (n=127), 66.1% (n=84) of them were in the High Morning Fatigue class. Of those patients in the Low Morning Fatigue class (n=185), 41.6% were in the Moderate Evening Fatigue class (n=77), 20% were in the High Evening class, and 38.4% were in the Very High Evening Fatigue class.
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