Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

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

doi:10.1016/j.jpainsymman.2015.02.016

Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

J Pain Symptom Manage. 2015 Aug;50(2):176-89. doi: 10.1016/j.jpainsymman.2015.02.016. Epub 2015 Mar 28.

Authors

Affiliations

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 the most common symptom in oncology patients during chemotherapy. 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 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 morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index, 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 body mass index, 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.

Keywords: Morning fatigue; cancer; chemotherapy; diurnal variations; evening fatigue; hierarchical linear modeling; oncology; symptom trajectories.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Agents / adverse effects
Antineoplastic Agents / therapeutic use
Body Mass Index
Depression / physiopathology
Disease Progression
Fatigue / diagnosis*
Fatigue / physiopathology*
Female
Humans
Linear Models
Male
Middle Aged
Neoplasms / diagnosis
Neoplasms / drug therapy*
Neoplasms / physiopathology*
Neoplasms / psychology
Outpatients
Periodicity
Photoperiod*
Risk Factors
Severity of Illness Index
Sleep Wake Disorders / physiopathology

Substances

Antineoplastic Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding