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. 2025 Mar-Apr;48(2):E75-E89.
doi: 10.1097/NCC.0000000000001304. Epub 2024 Jan 23.

Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy

Philip Garcia  1 , Astrid Block, Sueann Mark, Lynda Mackin, Steven M Paul, Bruce A Cooper, Yvette P Conley, Marilyn J Hammer, Jon D Levine, Christine Miaskowski
Affiliations

Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy

Philip Garcia et al. Cancer Nurs. 2025 Mar-Apr.

Abstract

Background: Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms.

Objectives: The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping.

Methods: Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles.

Results: Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment.

Conclusions: More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles.

Implications for practice: Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

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