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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. 1Duke University, Durham, North Carolina, USA
  2. 2Duke Cancer Institute, Durham, North Carolina, USA
  3. 3School of Nursing, University of California, San Francisco, California, USA
  4. 4Dana Farber Cancer Institute, Boston, Massachusetts, USA
  5. 5New York University, New York, New York, USA
  6. 6University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7School 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.

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