title: Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Wright
authors.affiliation: Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: D'Eramo Melkus
authors.affiliation: Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hammer
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Dentistry, New York University, New York, New York, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Schmidt
authors.affiliation: Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut, USA.
authors.forename: M Tish
authors.initials: MT
authors.lastname: Knobf
authors.affiliation: Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Mount Sinai Health System, New York, New York, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Cartwright
authors.affiliation: Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Mastick
authors.affiliation: Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Lee-May
authors.initials: LM
authors.lastname: Chen
authors.affiliation: Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Melisko
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Kord
authors.initials: K
authors.lastname: Kober
authors.affiliation: 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.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Aouizerat
authors.affiliation: Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA. Electronic address: chris.miaskowski@nursing.ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D003863:Depression / Q000503:physiopathology; D018450:Disease Progression; D005221:Fatigue / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D010045:Outpatients; D010507:Periodicity; D017440:Photoperiod; D012307:Risk Factors; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000503:physiopathology
chemical_list: D000970:Antineoplastic Agents
keywords: Morning fatigue; cancer; chemotherapy; diurnal variations; evening fatigue; hierarchical linear modeling; oncology; symptom trajectories
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