Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

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

doi:10.1016/j.jpainsymman.2015.02.016

Cited by 52 publications

(55 citation statements)

References 69 publications

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“…First, for both fatigue and energy, the receipt of adjuvant CTX was associated with membership in the class with the poorer outcomes. While higher levels of fatigue are associated with the receipt of CTX,(84–86) this study is the first to document an association between receipt of adjuvant CTX and decrements in energy levels. Second, for both symptoms, clinically meaningful levels of fatigue and decrements in energy levels, prior to surgery , were associated with membership in the Higher Fatigue and Lower Energy classes, respectively.…”

Section: Discussionmentioning

confidence: 68%

Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery

Kober

Smoot

Paul

et al. 2016

Journal of Pain and Symptom Management

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Context Little is known about the phenotypic and molecular characteristics associated with changes over time in fatigue and lack of energy in patients with breast cancer. Objectives To identify subgroups (i.e., latent classes) of women with distinct fatigue and energy trajectories; evaluate for differences in phenotypic characteristics between the latent classes for fatigue and energy; and evaluate for associations between polymorphisms in genes for pro- and anti-inflammatory cytokines, their receptors, and their transcriptional regulators and latent class membership. Methods Patients were enrolled prior to and followed for six months after breast cancer surgery. Latent class analyses were done to identify subgroups of patients with distinct fatigue and energy trajectories. Candidate gene analyses were done to identify cytokine genes associated with these two symptoms. Results For both fatigue and lack of energy, two distinct latent classes were identified. Phenotypic characteristics associated with the higher fatigue class were: younger age, higher education, lower KPS score, higher comorbidity, higher number of lymph nodes removed, and receipt of chemotherapy (CTX). Polymorphisms in interleukin (IL) 1 beta and IL10 were associated with membership in the higher fatigue class. Phenotypic characteristics associated with the lower energy class included: a lower KPS score and a higher comorbidity score. A polymorphism in IL1R1 was associated with membership in the lower energy class. Conclusion Within each latent class, the severity of fatigue and decrements in energy were relatively stable over the first six months following breast cancer surgery. Distinct phenotypic characteristics and genetic polymorphisms were associated with membership in the higher fatigue and lower energy classes.

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Section: Discussionmentioning

confidence: 68%

Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery

Kober

Smoot

Paul

et al. 2016

Journal of Pain and Symptom Management

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“…All of these studies would provide needed information to support the development and testing of interventions to decrease fatigue. In our companion paper, 65 information is provided on the trajectories and predictors of morning fatigue that will fill an important gap on diurnal variability in fatigue severity.…”

Section: Discussionmentioning

confidence: 99%

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Wright

Melkus

Hammer

et al. 2015

Journal of Pain and Symptom Management

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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.

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“…This study included patients who were part of a larger, longitudinal study that evaluated the symptom experience of oncology outpatients receiving CTX (Kober, Cooper, et al, 2016; Kober, Dunn, et al, 2016; Langford et al, 2016; Wright et al, 2015). Eligible patients were ≥18 years of age; had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received CTX within the preceding four weeks; were scheduled to receive at least two additional cycles of CTX; were able to read, write, and understand English; and gave written informed consent.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress.

Langford¹,

Cooper²,

Paul³

et al. 2017

Health Psychology

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OBJECTIVE Lifetime stressful life events (SLEs) may predispose oncology patients to cancer-related distress (i.e., intrusive thoughts, hyperarousal, avoidance). Coping may influence cancer-related distress by mediating this relationship. This study sought to: 1) determine the prevalence and impact of lifetime SLEs among oncology outpatients receiving chemotherapy and 2) examine the relationship between SLEs and cancer-related distress and the mediating role of coping on this relationship. METHODS Patients (n=893), with breast, gastrointestinal, gynecologic or lung cancer, who were undergoing chemotherapy, completed the Life Stressor Checklist-Revised (LSC-R), a measure of lifetime SLEs. Cancer-related distress was assessed with the Impact of Event Scale-Revised (IES-R). Coping strategies since beginning chemotherapy were assessed with the Brief COPE; two latent variables (engagement and disengagement coping) were identified based on these scores. LSC-R scores (number of SLEs and perceived impact during the prior year) were evaluated in relation to demographic and clinical characteristics. Structural equation modeling was used to evaluate the relationship between LSC-R and IES-R scores and the mediating role of engagement and disengagement coping on this relationship. RESULTS On average, patients reported 6.0 (standard deviation 4.0; range 0–23 out of 30) SLEs. Patients who were not married/partnered, lived alone, had incomes <$30,000/year, or who had lower functional status or greater comorbidity had higher LSC-R scores. The relationship between more SLEs and more severe cancer-related distress was completely mediated by disengagement coping. Engagement coping did not mediate this relationship. CONCLUSIONS Disengagement coping, including behavioral disengagement, avoidance, and denial, should be targeted to mitigate cancer-related distress.

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Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

Cited by 52 publications

References 69 publications

Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery

Polymorphisms in Cytokine Genes Are Associated With Higher Levels of Fatigue and Lower Levels of Energy in Women After Breast Cancer Surgery

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Evaluation of coping as a mediator of the relationship between stressful life events and cancer-related distress.

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