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. 2025 Feb 18;52(2):E35-E57.
doi: 10.1188/25.ONF.E35-E57.

Distinct Morning and Evening Fatigue Profiles in Patients With Gynecologic Cancers Receiving Chemotherapy

David Ayangba Asakitogum  1 , Jerry John Nutor  2 , Marilyn J Hammer  3 , Rachel A Pozzar  4 , Bruce A Cooper  5 , Steven M Paul  6 , Yvette P Conley  7 , Jon D Levine  8 , Christine Miaskowski  9
Affiliations

Distinct Morning and Evening Fatigue Profiles in Patients With Gynecologic Cancers Receiving Chemotherapy

David Ayangba Asakitogum et al. Oncol Nurs Forum. .

Abstract

Objectives: To identify distinct morning and evening fatigue profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, common symptoms, and quality-of-life outcomes.

Sample & setting: Outpatients with gynecologic cancers (N = 233) were recruited before their second or third cycles of chemotherapy at four cancer centers in San Francisco Bay and New York.

Methods & variables: The Lee Fatigue Scale was completed six times over two cycles of chemotherapy in the morning and in the evening. Latent profile analysis was used to identify distinct morning and evening fatigue profiles.

Results: Four distinct morning and two distinct evening fatigue classes were identified. Common risk factors for morning and evening fatigue included younger age, higher body mass index, lower functional status, and higher comorbidity burden. Patients in the worst morning and evening fatigue classes reported higher levels of anxiety, depression, and sleep disturbance; lower levels of energy and cognitive function; and poorer quality of life.

Implications for nursing: Clinicians can use this information to identify higher-risk patients and develop individualized interventions for morning and evening fatigue.

Keywords: chemotherapy; evening fatigue; gynecologic cancer; morning fatigue; quality of life.

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Figures

FIGURE 1
FIGURE 1
Trajectories of Morning Fatigue for the 4 Latent Classes (A) and Trajectories of Evening Fatigue for the 2 Latent Classes (B)
FIGURE 2
FIGURE 2
Differences in SF-12® Scores (A) and MQOLS-PV Scores (B) Among the Morning Fatigue Latent Classes BP—bodily pain; GH—general health; MCS—mental component summary; MH—mental health; MQOLS-PV— Multidimensional Quality of Life Scale–Patient Version; PCS—physical component summary; PF—physical functioning; QOL—quality of life; RE—role emotional; RP—role physical; SF—social functioning; VT—vitality Note. Figure 2A shows differences in SF-12 PF, RP, BP, GH, VT, SF, RE, MH, PCS, and MCS scores among the morning fatigue classes. All values are plotted as means and SDs. For the SF-12, compared to the Low class, patients in the High and Very High classes had significantly lower PF, RP, BP, VT, SF, RE, and MH scores. Compared to the Changing and High classes, patients in the Very High class had significantly lower RP, BP, VT, and MCS scores. Compared to the Low class, patients in the Changing and High classes had significantly lower PCS scores (all p < 0.05). Note. Figure 2B shows differences in MQOLS-PV scores for the physical, psychological, social, and spiritual well-being domains as well as total QOL among the morning fatigue latent classes. All values are plotted as means and SDs. For the MQOLS-PV, compared to the Low class, patients in the other 3 classes had significantly lower physical well-being and total QOL scores. Compared to the Changing and High classes, patients in the Very High class had significantly lower physical well-being, psychological well-being, social well-being, and total QOL scores (all p < 0.05).
FIGURE 3
FIGURE 3
Differences in SF-12® Scores (A) and MQOLS-PV Scores (B) Between the Evening Fatigue Latent Classes BP—bodily pain; GH—general health; MCS—mental component summary; MH—mental health; MQOLS-PV—Multidimensional Quality of Life Scale–Patient Version; PCS—physical component summary; PF—physical functioning; QOL—quality of life; RE—role emotional; RP—role physical; SF—social functioning; VT—vitality Note. Figure 3A shows differences in SF-12 PF, RP, BP, GH, VT, SF, RE, MH, PCS, and MCS scores between the evening fatigue classes. All values are plotted as means and SDs. For the SF-12, compared to the Low class, patients in the High class had lower RP, BP, GH, VT, SF, PCS, and MCS scores (all p < 0.05). Note. Figure 3B shows differences in MQOLS-PV scores for the physical, psychological, social, and spiritual well-being domains as well as total QOL between the evening fatigue classes. All values are plotted as means and SDs. For the MQOLS-PV, compared to the Low class, patients in the High class had lower physical well-being, psychological well-being, social well-being, and total QOL scores (all p < 0.05).
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References

    1. Agarwal S, Garg R, Minhas V, Bhatnagar S, Mishra S, Kumar V, Khan MA. To assess the prevalence and predictors of cancer-related fatigue and its impact on quality of life in advanced cancer patients receiving palliative care in a tertiary care hospital: A cross-sectional descriptive study. Indian Journal of Palliative Care. 2020;26(4):523–527. doi: 10.4103/ijpc.Ijpc_223_19. - DOI - PMC - PubMed
    1. Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Miaskowski C. Systematic review of the literature on multiple co-occurring symptoms in patients receiving treatment for gynecologic cancers. Seminars in Oncology Nursing. 2024;40(1):151572. doi: 10.1016/j.soncn.2023.151572. - DOI - PubMed
    1. Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): Validation of a screening instrument for use in medical settings. Journal of Studies on Alcohol. 1995;56(4):423–432. doi: 10.15288/jsa.1995.56.423. - DOI - PubMed
    1. Bower JE. Cancer-related fatigue—Mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology. 2014;11(10):597–609. doi: 10.1038/nrclinonc.2014.127. - DOI - PMC - PubMed
    1. Brintzenhofe-Szoc KM, Levin TT, Li Y, Kissane DW, Zabora JR. Mixed anxiety/depression symptoms in a large cancer cohort: Prevalence by cancer type. Psychosomatics. 2009;50(4):383–391. doi: 10.1176/appi.psy.50.4.383. - DOI - PubMed

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