Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

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. While 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 (CTX). Objectives To determine whether demographic, clinical, and symptom characteristics were associated with initial levels as well as 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 CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) 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, child care 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 non-modifiable (e.g., ethnicity) and modifiable (e.g., child care 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.

Distinct evening fatigue profiles in oncology outpatients receiving chemotherapy

“…Based on our previous [12] and current LPAs, as well as an HLM analysis,[14] the phenotypic characteristics associated with membership in the Very High evening fatigue classes, as well as higher evening fatigue scores are summarized in Table 3. The remainder of the discussion describes these characteristics within the context of the published literature on evening fatigue.…”

“…[12,14] In brief, eligible patients had a diagnosis of breast, GI, GYN, or lung cancer; had received CTX within the preceding four weeks; were scheduled for at least two additional CTX cycles; were ≥18 years of age; could read, write, and understand English; and gave written informed consent. Patients were recruited from two Comprehensive Cancer Centers, one Veteran’s Affairs hospital, and four community-based oncology programs.…”

“…[2] While a growing body of evidence suggests that average fatigue severity is associated with a number of demographic and clinical characteristics,[3–10] these studies did not evaluate diurnal variations in fatigue severity. Recent work by our research team [11–14] and others [15–17] found that fatigue severity is extremely variable over the course of a day and among individuals. However, the majority of the studies cited above used correlational methods of analysis, which are unable to capture patterns of within group variation.…”

Differences in symptom occurrence, severity, and distress ratings between patients with gastrointestinal cancers who received chemotherapy alone or chemotherapy with targeted therapy

“…This study is part of a larger descriptive, longitudinal study of the symptom experience of oncology outpatients who received CTX (32,33). Eligible patients were ≥18 years of age; had a diagnosis of breast, GI, lung, or gynecological cancer; had received CTX within the preceding four weeks; were scheduled to receive at least two additional cycles of CTX; were able to read, write, and understand English; and provided informed consent.…”

Identifying the subtypes of cancer-related fatigue: results from the population-based PROFILES registry

“…However, little research has been done to classify cancer survivors according to CRF subtypes and to identify factors associated with the subtypes. In a study that focused only on physical CRF, distinct predictors and trajectories of morning and evening physical CRF were identified in on-treatment patients [15,16]. It is intuitive that better classification of CRF can have implications for prognosis and response to treatment.…”