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Fatigue in patients receiving chemotherapy: Patterns of change

Richardson, Alison Ph.D., M.Sc, B.N., R.G.N., P.G.D.E., R.N.T.; Ream, Emma M.Sc., B.Sc., R.G.N.; Wilson-Barnett, Jenifer Ph.D., M.Sc., B.A., R.G.N., R.N.T., F.R.C.N.

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Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy. The diary comprised four visual analogue scales measuring selected dimensions of fatigue: extent of fatigue, distress caused by fatigue, the influence of fatigue on the ability to engage in social activities, and the impact of fatigue on workrelated activities. The patients' diaries produced detailed time series of data that captured the dynamics of their fatigue. Analyses of these data revealed the patterns of fatigue after the administration of chemotherapy, which appear strongly related to both the timing of treatment and the manner in which cytotoxic agents are administered. Furthermore, Kruskal-Wallis tests performed to compare fatigue among subgroups of patients revealed that it is statistically associated with particular types of cancer, specific chemotherapy regimens, and certain methods of drug administration. Fatigue varied throughout the day, more frequently occurring in the afternoon and early evening. These insights, gained during this study about the likely pattern of fatigue in the period after the administration of chemotherapy, and the potential benefits of maintaining a fatigue diary could be utilized by nurses engaged in the care of chemotherapy patients.

Dr. Alison Richardson is Clinical Service Manager, Cancer Services, Chartwell Unit, Bromley Hospitals NHS Trust, Orpington, Kent. At the time of manuscript submission, Dr. Richardson was Macmillan Lecturer in Cancer Nursing and Palliative Care, Department of Nursing Studies, King's College, University of London.

Emma Ream is Research Associate, Department of Nursing Studies, King's College, University of London.

Professor Jenifer Wilson-Barnett is Head of the Department of Nursing Studies and the Division of Nursing and Midwifery, King's College, University of London.

Address correspondence and reprint requests to Dr. Alison Richardson, Chartwell Unit, Bromley Hospitals NHS Trust, Farnborough Hospital, Farnborough Common, Orpington, Kent BR6 8ND, United Kingdom.

Accepted for publication April 25, 1997.

© Lippincott-Raven Publishers