Trajectories of evening fatigue in oncology outpatients receiving chemotherapy

Fay Wright, Gail D'Eramo Melkus, Marilyn Hammer, Brian Schmidt, M. Tish Knobf, Steven M. Paul, Frances Cartwright, Judy Mastick, Bruce A. Cooper, Lee May Chen, Michelle Melisko, Jon D. Levine, Kord Kober, Bradley Aouizerat, Christine Miaskowski

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)163-175
Number of pages13
JournalJournal of Pain and Symptom Management
Volume50
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Fatigue
Outpatients
Drug Therapy
Lung Neoplasms
Sleep
Demography
Depression
Gastrointestinal Neoplasms
Patient Education
Self Care
Breast
Breast Neoplasms
Education

Keywords

  • breast cancer
  • chemotherapy
  • diurnal variations
  • Evening fatigue
  • gastrointestinal cancer
  • gynecological cancer
  • hierarchical linear modeling
  • lung cancer
  • symptom patterns
  • symptom trajectories

ASJC Scopus subject areas

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

Cite this

Trajectories of evening fatigue in oncology outpatients receiving chemotherapy. / Wright, Fay; D'Eramo Melkus, Gail; Hammer, Marilyn; Schmidt, Brian; Knobf, M. Tish; Paul, Steven M.; Cartwright, Frances; Mastick, Judy; Cooper, Bruce A.; Chen, Lee May; Melisko, Michelle; Levine, Jon D.; Kober, Kord; Aouizerat, Bradley; Miaskowski, Christine.

In: Journal of Pain and Symptom Management, Vol. 50, No. 2, 01.08.2015, p. 163-175.

Research output: Contribution to journalArticle

Wright, F, D'Eramo Melkus, G, Hammer, M, Schmidt, B, Knobf, MT, Paul, SM, Cartwright, F, Mastick, J, Cooper, BA, Chen, LM, Melisko, M, Levine, JD, Kober, K, Aouizerat, B & Miaskowski, C 2015, 'Trajectories of evening fatigue in oncology outpatients receiving chemotherapy', Journal of Pain and Symptom Management, vol. 50, no. 2, pp. 163-175. https://doi.org/10.1016/j.jpainsymman.2015.02.015
Wright, Fay ; D'Eramo Melkus, Gail ; Hammer, Marilyn ; Schmidt, Brian ; Knobf, M. Tish ; Paul, Steven M. ; Cartwright, Frances ; Mastick, Judy ; Cooper, Bruce A. ; Chen, Lee May ; Melisko, Michelle ; Levine, Jon D. ; Kober, Kord ; Aouizerat, Bradley ; Miaskowski, Christine. / Trajectories of evening fatigue in oncology outpatients receiving chemotherapy. In: Journal of Pain and Symptom Management. 2015 ; Vol. 50, No. 2. pp. 163-175.
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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.",
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AU - Knobf, M. Tish

AU - Paul, Steven M.

AU - Cartwright, Frances

AU - Mastick, Judy

AU - Cooper, Bruce A.

AU - Chen, Lee May

AU - Melisko, Michelle

AU - Levine, Jon D.

AU - Kober, Kord

AU - Aouizerat, Bradley

AU - Miaskowski, Christine

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N2 - 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.

AB - 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.

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