Predictors and trajectories of morning fatigue are distinct from evening fatigue

Fay Wright, Gail D'Eramo Melkus, Marilyn Hammer, Brian L. Schmidt, M. Tish Knobf, Steven M. Paul, Frances Cartwright, Judy Mastick, Bruce A. Cooper, Lee May Chen, Michelle Melisko, Jon D. Levine, Kord Kober, Bradley E. Aouizerat, Christine Miaskowski

Research output: Contribution to journalArticlepeer-review


Context Fatigue is the most common symptom in oncology patients during chemotherapy. Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients. Objectives An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on 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 morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index, who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance, and depressive symptoms reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients' ethnicity and younger age. Conclusion The modifiable risk factors that were associated with only morning fatigue were body mass index, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Original languageEnglish (US)
Pages (from-to)176-189
Number of pages14
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Aug 1 2015


  • Morning fatigue
  • cancer
  • chemotherapy
  • diurnal variations
  • evening fatigue
  • hierarchical linear modeling
  • oncology
  • symptom trajectories

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Predictors and trajectories of morning fatigue are distinct from evening fatigue'. Together they form a unique fingerprint.

Cite this