Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Disease Progression
  • Fatigue / diagnosis
  • Fatigue / physiopathology*
  • Female
  • Humans
  • Linear Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Neoplasms / physiopathology*
  • Outpatients
  • Periodicity
  • Photoperiod*
  • Risk Factors
  • Severity of Illness Index

Substances

  • Antineoplastic Agents