Fay Wright1, Gail D'Eramo Melkus1, Marilyn Hammer1, Brian L Schmidt2, M Tish Knobf3, Steven M Paul4, Frances Cartwright5, Judy Mastick4, Bruce A Cooper4, Lee-May Chen6, Michelle Melisko7, Jon D Levine8, Kord Kober4, Bradley E Aouizerat9, Christine Miaskowski10. 1. Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA. 2. Department of Oral and Maxillofacial Surgery, School of Dentistry, New York University, New York, New York, USA. 3. Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut, USA. 4. Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA. 5. Mount Sinai Health System, New York, New York, USA. 6. Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California, USA. 7. Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA. 8. Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California at San Francisco, San Francisco, California, USA. 9. Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA; The Institute for Human Genetics, University of California at San Francisco, San Francisco, California, USA. 10. Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA. Electronic address: chris.miaskowski@nursing.ucsf.edu.
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.
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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