title: Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy.
abstract: BACKGROUND
  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. Although 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.
  
  
  OBJECTIVE
  To determine whether demographic, clinical, and symptom characteristics were associated with initial levels and 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 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 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, childcare responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment.
  
  
  CONCLUSIONS
  This study identified both nonmodifiable (e.g., ethnicity) and modifiable (e.g., childcare 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.
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; D018450:Disease Progression; D005221:Fatigue / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology*; D010045:Outpatients; D010507:Periodicity; D017440:Photoperiod; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000970:Antineoplastic Agents
keywords: Evening fatigue; breast cancer; chemotherapy; diurnal variations; gastrointestinal cancer; gynecological cancer; hierarchical linear modeling; lung cancer; symptom patterns; symptom trajectories
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