Trajectories of evening fatigue in oncology outpatients receiving chemotherapy

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 a distressing persistent sense of physical tiredness that is not proportional to a person's recent activity. Fatigue impacts patients' treatment decisions and can limit their self-care activities. Although significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy. Objectives To determine whether demographic, clinical, and symptom characteristics were associated with initial levels and the trajectories of 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 evening fatigue trajectories. A piecewise model fit the data best. Patients who were white, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, childcare responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. Conclusion This study identified both nonmodifiable (e.g., ethnicity) and modifiable (e.g., childcare responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

Original languageEnglish (US)
Pages (from-to)163-175
Number of pages13
JournalJournal of Pain and Symptom Management
Issue number2
StatePublished - Aug 1 2015


  • Evening fatigue
  • breast cancer
  • chemotherapy
  • diurnal variations
  • gastrointestinal cancer
  • gynecological cancer
  • hierarchical linear modeling
  • lung cancer
  • symptom patterns
  • symptom trajectories

ASJC Scopus subject areas

  • General Nursing
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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