Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy

Fay Wright, Kord M. Kober, Bruce A. Cooper, Steven M. Paul, Yvette P. Conley, Marilyn Hammer, Jon D. Levine, Christine Miaskowski

Research output: Contribution to journalArticle


Purpose: A cancer diagnosis and associated treatments are stressful experiences for most patients. Patients’ perceptions of stress and their use of coping strategies may influence fatigue severity. This study extends our previous work describing distinct profiles of morning (i.e., Very Low, Low, High, and Very High) and evening (i.e., Low, Moderate, High, and Very High) fatigue in oncology patients by evaluating for differences in stress and coping strategies among these fatigue classes. Methods: This longitudinal study evaluated for changes in morning and evening fatigue in oncology patients (n = 1332) over two cycles of chemotherapy (CTX). Patients completed measures of cumulative exposure to stressful life events (SLEs) (i.e., the Life Stressor Checklist-Revised), general stress (i.e., Perceived Stress Scale [PSS]), cancer-specific stress (i.e., Impact of Event Scale-Revised [IES-R]), and coping strategies (i.e., Brief Cope). Differences among the latent classes were evaluated using analyses of variance, Kruskal-Wallis, or chi-square tests. Results: Patients in both the Very High morning and evening fatigue classes reported higher numbers of and a higher impact from previous SLEs and higher PSS scores than the other fatigue classes. The IES-R scores for the Very High morning fatigue class met the criterion for subsyndromal PTSD. Patients in the Very High evening fatigue class used a higher number of engagement coping strategies compared with the Very High morning fatigue class. Conclusions: Our findings suggest that interventions to reduce stress and enhance coping warrant investigation to decrease fatigue in patients undergoing CTX.

Original languageEnglish (US)
JournalSupportive Care in Cancer
StatePublished - Jan 20 2020



  • Cancer
  • Chemotherapy
  • Coping
  • Cumulative life stress
  • Evening fatigue
  • Morning fatigue
  • Stress

ASJC Scopus subject areas

  • Oncology

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