Distinct evening fatigue profiles in oncology outpatients receiving chemotherapy

Abstract

Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.

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

“…Descriptive statistics and frequency distributions were calculated for the stress and coping measures. As previously reported [6,7], LPA was used to identify patient subgroups with distinct morning or evening fatigue profiles over the six assessments. We used the identified profiles in these analyses.…”

“…Patients' main reason for refusal was feeling overwhelmed with their CTX treatment. Additional methodological details are described elsewhere [6,7].…”

“…In terms of differences in demographic and clinical characteristics among the latent classes [6,7], in brief, the overall sample was predominantly female, white, and college educated. Compared with the other fatigue classes, patients in both the Very High morning and evening fatigue classes were younger and reported a higher comorbidity burden.…”

“…One study found that increased exposure to SLEs was associated with greater fatigue severity in women with breast cancer; however, the effects of coping were not evaluated [23]. Given the paucity of research on the relationships between stress and coping and fatigue, the purpose of this study was to evaluate for differences in cumulative exposure to SLEs, general stress, cancer-specific stress, and coping strategies among our previously identified morning [6] and evening [7] fatigue classes.…”

“…Inter-individual variability in fatigue severity is influenced by demographic, clinical, psychological, behavioral, and biological characteristics [5]. In prior work [6,7], we described four classes of oncology patients (N = 1332) with distinct profiles of morning and evening fatigue severity, and demographic, clinical, and co-occurring symptom characteristics that distinguished among these classes. Using clinically meaningful cutoff scores for the Lee Fatigue Scale (i.e., 3.2 for morning and 5.6 for evening), we labeled the four distinct morning (i.e., Very Low, Low, High, and Very High) [6] and four distinct evening (i.e., Low, Moderate, High, and Very High) [7] fatigue profiles derived using latent profile analysis (LPA; see Supplemental Figure 1).…”