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

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

doi:10.1007/s00520-020-05303-5

Cited by 21 publications

(25 citation statements)

References 59 publications

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“…Previous studies support the importance of psychosocial factors as predictors of fatigue trajectories during and after treatment. In a large, representative sample of patients with cancer who were undergoing chemotherapy (1332 patients), the 2 high fatigue groups reported more lifetime stress exposure as well as higher levels of cancer‐related stress 20 . In our previous study with survivors of breast cancer after treatment, psychological factors emerged as the strongest predictors of membership in the high fatigue groups, particularly depressive symptoms and childhood adversity 17 …”

Section: Discussionmentioning

confidence: 97%

“…This may be particularly relevant for capturing the effects of endocrine therapy, which many women still were receiving at the 18‐month follow‐up. Fourth, we did not evaluate diurnal patterns of fatigue, which may have unique predictors 20 . Fifth, we focused on general fatigue, which includes feelings of being tired, worn out, and sluggish; other dimensions of fatigue (eg, physical fatigue and/or cognitive fatigue) may have unique trajectories and predictors 19 .…”

Section: Discussionmentioning

confidence: 99%

“…19 We also assessed medical and psychosocial factors that have been correlated with fatigue and may drive its onset and persistence. Previous studies of cancer-related fatigue trajectories have shown that medical comorbidities, 4,15 body mass index, 16,17 physical activity, 14,16 sleep disturbance, 17 and cancer-related stress 20 each are associated with fatigue and were included in the current report.…”

Section: Introductionmentioning

confidence: 99%

“…Fourth, we did not evaluate diurnal patterns of fatigue, which may have unique predictors. 20 Fifth, we focused on general fatigue, which includes feelings of being tired, worn out, and sluggish; other dimensions of fatigue (eg, physical fatigue and/or cognitive fatigue) may have unique trajectories and predictors. 19 Finally, because there was no comparison group of individuals without cancer, we were unable to confirm that the observed trajectories were specific to patients with breast cancer.…”

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confidence: 99%

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Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer

Bower

Ganz

Irwin

et al. 2021

Cancer

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BACKGROUND: Fatigue is a common and expected side effect of cancer treatment. However, the majority of studies to date have focused on average levels of fatigue, which may obscure important individual differences in the severity and course of fatigue over time. The current study was designed to identify distinct trajectories of fatigue from diagnosis into survivorship in a longitudinal study of women with early-stage breast cancer. METHODS: Women with stage 0 to stage IIIA breast cancer (270 women) were recruited before (neo)adjuvant therapy with radiotherapy, chemotherapy, and/or endocrine therapy and completed assessments at baseline; posttreatment; and at 6 months, 12 months, and 18 months of follow-up. Growth mixture modeling was used to identify trajectories of fatigue, and differences among the trajectory groups with regard to demographic, medical, and psychosocial variables were examined. RESULTS: Five distinct trajectories of fatigue were identified: Stable Low (66%), with low levels of fatigue across assessments; Stable High (13%), with high fatigue across assessments; Decreasing (4%), with high fatigue at baseline that resolved over time; Increasing (9%), with low fatigue at baseline that increased over time; and Reactive (8%), with increased fatigue after treatment that resolved over time. Both psychological and treatment-related factors were found to be associated with fatigue trajectories, with psychological factors most strongly linked to high fatigue at the beginning of and over the course of treatment. CONCLUSIONS: There is considerable variability in the experience of fatigue among women with early-stage breast cancer. Although the majority of women report relatively low fatigue, those with a history of depression and elevated psychological distress may be at risk of more severe and persistent fatigue.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer

Bower

Ganz

Irwin

et al. 2021

Cancer

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“…Although fatigue occurs in 60%–90% of oncology patients, 24 recent evidence suggests that higher levels of stress correlated with increased fatigue in oncology patients undergoing chemotherapy. 25 Sleep disturbance is reported by 30%–88% of oncology patients. 26 , 27 Although findings from preclinical and clinical studies suggest that stress has a negative impact on the sleep-wake cycle, 28 , 29 no data are available on the relationship between stress and sleep disturbance in oncology patients.…”

Section: Introductionmentioning

confidence: 99%

Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic

Miaskowski

Paul

Snowberg

et al. 2020

Journal of Pain and Symptom Management

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100

120

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Context. No information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic. Objectives. To evaluate for differences in demographic and clinical characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the highstressed group. Methods. Patients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey. Results. Of the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event ScaledRevised [score of $24]). Stressed group's Impact of Event ScaledRevised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom. Conclusion. We identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients. J Pain Symptom Manage 2020;60:e25ee34.

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Various types of stress and greater use of disengagement coping are associated with worse sleep disturbance in oncology patients undergoing chemotherapy

et al. 2023

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Various types of stress and the choice of coping strategies may be risk factors for higher levels of sleep disturbance in oncology patients. Purposes were to evaluate for differences in global, cancer‐specific, and cumulative life stress, as well as resilience and the use of coping strategies among three subgroups of patients with distinct sleep disturbance profiles (i.e., Low, High, Very High). Oncology outpatients (n = 1331) completed measures of global (Perceived Stress Scale), cancer‐specific (Impact of Event Scale‐Revised), and cumulative life (Life Stressor Checklist‐Revised) stress, resilience (Connor‐Davidson Resilience Scale) and coping (Brief Cope) prior to their second or third cycle of chemotherapy. Sleep disturbance was assessed six times over two chemotherapy cycles. Differences were evaluated using parametric and non‐parametric tests. All stress measures showed a dose response effect (i.e., as the sleep disturbance profile worsened, levels of all types of stress increased). Compared to Low class, the other two classes reported higher levels of global perceived stress and higher occurrence rates and effect from previous stressful life events. Impact of Event Scale‐Revised scores for the Very High class indicated post‐traumatic symptomatology. Patients in High and Very High classes had resilience scores below the normative score for the United States population and used a higher number of disengagement coping strategies. Our findings suggest that very high levels of sleep disturbance are associated with higher levels of various types of stress, lower levels of resilience, and higher use of disengagement coping strategies. Clinicians need to perform routine assessments and implement symptom management interventions to reduce stress and encourage the use of engagement coping strategies.

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

Cited by 21 publications

References 59 publications

Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer

Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer

Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic

Various types of stress and greater use of disengagement coping are associated with worse sleep disturbance in oncology patients undergoing chemotherapy

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