Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy

Hamza Abid, Kord M. Kober, Betty Smoot, Steven M. Paul, Marilyn Hammer, Jon D. Levine, Kathryn Lee, Fay Wright, Bruce A. Cooper, Yvette P. Conley, Christine Miaskowski

Research output: Contribution to journalArticle


Context Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment. Objectives The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy. Methods Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data. Results A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time. Conclusion Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.

Original languageEnglish (US)
Pages (from-to)887-900.e2
JournalJournal of Pain and Symptom Management
Issue number5
StatePublished - May 2017



  • Morning energy
  • cancer
  • chemotherapy
  • diurnal variations
  • evening energy
  • hierarchical linear modeling
  • oncology
  • symptom trajectories

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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