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Distinct morning and evening fatigue profiles in gastrointestinal cancer during chemotherapy
  1. Yufen Lin1,
  2. Donald E Bailey1,
  3. Sharron L Docherty1,
  4. Laura S Porter2,
  5. Bruce Cooper3,
  6. Steven Paul3,
  7. Kord Kober3,
  8. Marilyn J Hammer4,
  9. Fay Wright5,
  10. Yvette Conley6,
  11. Jon Levine7 and
  12. Christine Miaskowski3
  1. 1 Duke University, Durham, North Carolina, USA
  2. 2 Duke Cancer Institute, Durham, North Carolina, USA
  3. 3 School of Nursing, University of California, San Francisco, California, USA
  4. 4 Dana Farber Cancer Institute, Boston, Massachusetts, USA
  5. 5 New York University, New York, New York, USA
  6. 6 University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7 School of Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Dr Christine Miaskowski, School of Nursing, UCSF, San Francisco, CA 94143, USA; chris.miaskowski{at}nursing.ucsf.edu

Abstract

Background Purposes were to identify subgroups of patients with gastrointestinal cancers with distinct morning and evening fatigue severity profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, co-occurring symptoms and quality of life (QOL) outcomes.

Methods Patients with gastrointestinal cancers (n=405) completed questionnaires six times over two cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening fatigue profiles. Differences in demographic and clinical characteristics, co-occurring symptoms and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests.

Results Two distinct mornings (ie, low and very high) and three distinct evenings (ie, low, moderate and very high) fatigue classes were identified. Common risk factors for both morning and evening fatigue included younger age, lower performance status, higher comorbidity burden and self-reported depression. Higher levels of morning fatigue were associated with being unmarried, living alone, being unemployed, having a lower income, lack of regular exercise and a self-reported diagnosis of anaemia. Higher levels of evening fatigue were associated with being women, white and having childcare responsibilities. Patients in the very high morning and evening fatigue classes reported higher levels of anxiety, depressive symptoms, sleep disturbance and pain and lower levels of attentional function and poorer QOL.

Conclusion Findings provide new insights into risk factors for and deleterious effects of morning and evening fatigue in patients with gastrointestinal cancers. Clinicians can use this information to identify high-risk patients and develop individualised interventions for morning and evening fatigue and other co-occurring symptoms.

  • depression
  • pain
  • quality of life
  • fatigue
  • gastrointestinal (lower)

Data availability statement

Data are available upon reasonable request. Data are available following the submission of a written proposal that is approved by the PI and co-investigators and following the completion of a data transfer agreement.

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Data availability statement

Data are available upon reasonable request. Data are available following the submission of a written proposal that is approved by the PI and co-investigators and following the completion of a data transfer agreement.

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Footnotes

  • Contributors YL, DEB, and CM conceived the study and wrote the initial draft of the manuscript; BC and SP performed the statistical analyses; all of the authors discussed the findings from this study, contributed to several revisions; and approved the final submission of the paper.

  • Funding This study was funded by a grant from the National Cancer Institute (CA134900). CM is an American Cancer Society Clinical Research Professor. YL is supported by an American Cancer Society doctoral scholarship and an Oncology Nursing Foundation Research Doctoral Scholarship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.