title: Common and Distinct Characteristics Associated With Trajectories of Morning and Evening Energy in Oncology Patients Receiving Chemotherapy.
abstract: Although energy conservation strategies are recommended in clinical practice guidelines, little is known about changes in energy levels in oncology patients undergoing cancer treatment.
  
  
  
  The objective of this study was to identify variations in the trajectories of morning and evening energy levels and determine which characteristics predicted initial levels and the trajectories of morning and evening energy.
  
  
  
  Outpatients receiving chemotherapy (CTX) completed demographic and symptom questionnaires six times over two CTX cycles. Energy was assessed using the Lee Fatigue Scale. Hierarchical linear modeling was used to analyze the data.
  
  
  
  A large amount of interindividual variability was found in the morning and evening energy trajectories. Patients who lived alone, had childcare responsibilities, had a lower functional status, did not exercise on a regular basis, had lower hemoglobin levels, had lower attentional function, higher trait anxiety, and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index and higher levels of morning energy and higher sleep disturbance scores. For evening energy, patients who were female, white, had lower functional status, and had lower attentional function and higher sleep disturbance reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time.
  
  
  
  Patients undergoing CTX experience decrements in both morning and evening energy. The modifiable characteristics associated with these decrements can be used to design intervention studies to increase energy levels in these patients.
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Hamza
authors.initials: H
authors.lastname: Abid
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Kord M
authors.initials: KM
authors.lastname: Kober
authors.affiliation: School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Smoot
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: Department of Nursing, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hammer
authors.affiliation: School of Medicine, University of California, San Francisco, California, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lee
authors.affiliation: School of Nursing, Yale University, New Haven, Connecticut, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Wright
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Yvette P
authors.initials: YP
authors.lastname: Conley
authors.affiliation: School of Nursing, University of California, San Francisco, California, USA. Electronic address: chris.miaskowski@ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002940:Circadian Rhythm / Q000187:drug effects*; D015897:Comorbidity; D015444:Exercise; D005221:Fatigue / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: Morning energy; cancer; chemotherapy; diurnal variations; evening energy; hierarchical linear modeling; oncology; symptom trajectories