RT Journal Article SR Electronic T1 Distinct morning and evening fatigue profiles in gastrointestinal cancer during chemotherapy JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP bmjspcare-2021-002914 DO 10.1136/bmjspcare-2021-002914 A1 Yufen Lin A1 Donald E Bailey A1 Sharron L Docherty A1 Laura S Porter A1 Bruce Cooper A1 Steven Paul A1 Kord Kober A1 Marilyn J Hammer A1 Fay Wright A1 Yvette Conley A1 Jon Levine A1 Christine Miaskowski YR 2021 UL http://spcare.bmj.com/content/early/2021/05/28/bmjspcare-2021-002914.abstract AB 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.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.