Cytokine Gene Associations With Self-Report Ratings of Morning and Evening Fatigue in Oncology Patients and Their Family Caregivers

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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.

Section: Discussionsupporting

confidence: 58%

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Wright

Melkus

Hammer

et al. 2015

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“…Another possible explanation for the inconsistent findings may be the effect of variations in cytokine genes on the associations between depressive symptoms and morning and evening fatigue. 42-44 For example, variations in the genes for tumor necrosis factor alpha (TNFA) were associated with morning fatigue (single nucleotide polymorphism [SNP] rs3093662) and evening fatigue (SNP rs2229094) 43 and with depressive symptoms (SNPs rs2229094 and rs1800629). 44 …”

Section: Discussionmentioning

confidence: 99%

Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

Wright

Melkus

Hammer

et al. 2015

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Context Fatigue is the most common symptom in oncology patients during chemotherapy (CTX). Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients. Objectives An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on 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 morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index (BMI), who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance and depressive symptoms, reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients’ ethnicity and younger age. Conclusion The modifiable risk factors that were associated with only morning fatigue were BMI, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

“…Our research team has used growth mixture modeling (GMM) to identify subgroups (i.e., latent classes) of oncology patients and their family caregivers (FCs) who differed in their experiences with depression, 13 sleep disturbance, 14 fatigue, 15 and attentional fatigue. 16 In all of these GMM analyses, the phenotypic and molecular data from patients and their FCs were combined for a number of reasons.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and Molecular Evidence Suggests That Decrements in Morning and Evening Energy Are Distinct but Related Symptoms

Aouizerat

Dhruva

Paul

et al. 2015

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Context Little is known about energy levels in oncology patients and their family caregivers (FCs). Objectives This study sought to identify latent classes of participants, based on self-reported energy levels and to evaluate for differences in phenotypic and genotypic characteristics between these classes. Methods Energy subscale scores from the Lee Fatigue Scale were used to determine latent class membership. Morning and evening energy scores were obtained just prior to, during, and for four months following the completion of radiation therapy. Genetic associations were evaluated for fifteen pro- and anti-inflammatory cytokine genes. Results Two latent classes with distinct morning energy trajectories were identified. Participants who were younger, female, not married/partnered, Black, and had more comorbidities, and a lower functional status were more likely to be in the Low Morning Energy class. Two polymorphisms (IL2 rs1479923, NFKB1 rs4648110) were associated with morning energy latent class membership. Two latent classes with distinct evening energy trajectories were identified. Participants who were younger and male and who had more comorbidities, decreased body weight, and a lower functional status were more likely to be in the Moderate Evening Energy class. Five different polymorphisms (IL1R2 rs4141134, IL6 rs4719714, IL17A rs8193036, NFKB2 rs1056890, TNFA rs1800683) were associated with evening energy latent class membership. Conclusion This study provides preliminary evidence that decrements in morning and evening energy are associated with different phenotypic risk factors as well as cytokine gene variations.