Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

doi:10.1080/21641846.2017.1322233

. 2017;5(3):131-144.

doi: 10.1080/21641846.2017.1322233. Epub 2017 May 18.

Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

Fay Wright¹, Bruce A Cooper², Yvette P Conley³, Marilyn J Hammer⁴, Lee-May Chen⁵, Steven M Paul², Jon D Levine⁵, Christine Miaskowski², Kord M Kober²

Affiliations

¹ School of Nursing, Yale University, New Haven, CT.
² School of Nursing, University of California, San Francisco, CA.
³ School of Nursing, University of Pittsburgh, Pittsburgh, PA.
⁴ Mount Sinai Medical Center, New York, NY.
⁵ School of Medicine, University of California, San Francisco, CA.

PMID: 29725554
PMCID: PMC5926814
DOI: 10.1080/21641846.2017.1322233

Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

Fay Wright et al. Fatigue. 2017.

. 2017;5(3):131-144.

doi: 10.1080/21641846.2017.1322233. Epub 2017 May 18.

Authors

Fay Wright¹, Bruce A Cooper², Yvette P Conley³, Marilyn J Hammer⁴, Lee-May Chen⁵, Steven M Paul², Jon D Levine⁵, Christine Miaskowski², Kord M Kober²

Affiliations

¹ School of Nursing, Yale University, New Haven, CT.
² School of Nursing, University of California, San Francisco, CA.
³ School of Nursing, University of Pittsburgh, Pittsburgh, PA.
⁴ Mount Sinai Medical Center, New York, NY.
⁵ School of Medicine, University of California, San Francisco, CA.

PMID: 29725554
PMCID: PMC5926814
DOI: 10.1080/21641846.2017.1322233

Abstract

Background: Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability.

Purpose: Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics.

Methods: Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles.

Results: Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment.

Conclusions: Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.

Keywords: chemotherapy; diurnal variations; evening fatigue; latent class analysis; symptom profiles.

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Figures

**Figure 1**
Trajectories of evening fatigue for the latent classes.

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[1] Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, Schnipper HH, Lacchetti C, Ligibel JA, Lyman GH, Ogaily MS, Pirl WF, Jacobsen PB American Society of Clinical Oncology. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32:1840–50. - PMC - PubMed

[2] Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, Schnipper HH, Lacchetti C, Ligibel JA, Lyman GH, Ogaily MS, Pirl WF, Jacobsen PB American Society of Clinical Oncology. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32:1840–50. - PMC - PubMed

[3] Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C National Comprehensive Cancer Network. Cancer-Related Fatigue, Version 2.2015. JNCCN. 2015;13:1012–39. - PMC - PubMed

[4] Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C National Comprehensive Cancer Network. Cancer-Related Fatigue, Version 2.2015. JNCCN. 2015;13:1012–39. - PMC - PubMed

[5] Bischel LE, Ritchie C, Kober KM, Paul SM, Cooper BA, Chen LM, Levine JD, Hammer M, Wright F, Miaskowski C. Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy. Eur J Oncol Nurs. 2016;23:115–23. - PMC - PubMed

[6] Bischel LE, Ritchie C, Kober KM, Paul SM, Cooper BA, Chen LM, Levine JD, Hammer M, Wright F, Miaskowski C. Age differences in fatigue, decrements in energy, and sleep disturbance in oncology patients receiving chemotherapy. Eur J Oncol Nurs. 2016;23:115–23. - PMC - PubMed

[7] Ancoli-Israel S, Liu L, Rissling M, Natarajan L, Neikrug AB, Palmer BW, Mills PJ, Parker BA, Sadler GR, Maglione J. Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Support Care Cancer. 2014;22:2535–45. - PMC - PubMed

[8] Ancoli-Israel S, Liu L, Rissling M, Natarajan L, Neikrug AB, Palmer BW, Mills PJ, Parker BA, Sadler GR, Maglione J. Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study. Support Care Cancer. 2014;22:2535–45. - PMC - PubMed

[9] Andrykowski MA, Donovan KA, Jacobsen PB. Magnitude and correlates of response shift in fatigue ratings in women undergoing adjuvant therapy for breast cancer. J Pain Symptom Manage. 2009;37:341–51. - PMC - PubMed

[10] Andrykowski MA, Donovan KA, Jacobsen PB. Magnitude and correlates of response shift in fatigue ratings in women undergoing adjuvant therapy for breast cancer. J Pain Symptom Manage. 2009;37:341–51. - PMC - PubMed

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Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

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Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy

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