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Morning Fatigue Severity Profiles in Oncology Outpatients Receiving Chemotherapy

Wright, Fay PhD, RN; Dunn, Laura B. MD; Paul, Steven M. PhD; Conley, Yvette P. PhD; Levine, Jon D. MD, PhD; Hammer, Marilyn J. PhD, RN; Cooper, Bruce A. PhD; Miaskowski, Christine PhD, RN; Kober, Kord M. PhD

doi: 10.1097/NCC.0000000000000626

Background Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability.

Objectives The aims of this study were to identify subgroups with distinct morning fatigue profiles and evaluate how these subgroups differed by demographic, clinical, and symptom characteristics.

Methods Outpatients (N = 1332) with breast, gastrointestinal, gynecological, or lung cancer completed questionnaires 6 times over 2 cycles of chemotherapy. Morning fatigue was assessed with the Lee Fatigue Scale. Latent profile analysis was used to identify distinct morning fatigue profiles.

Results Four morning fatigue profiles (ie, very low, low, high, and very high) were identified. In the high and very high classes, all 6 morning fatigue scores were higher than the clinical cutoff score. Compared with those in the very low and low classes, patients in the very high class were younger and not married/partnered; lived alone; had higher incomes, higher comorbidity, and higher body mass index; and did not exercise regularly. Across the 4 classes, functional status and attentional function scores decreased and anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue scores increased across the 2 cycles.

Conclusion Results provide insights into modifiable risk factors for morning fatigue. These risk factors can be used to develop more targeted interventions.

Implications for Practice Patients in the high and very high morning fatigue classes experienced high symptom and comorbidity burdens and significant decrements in functional status. Using this information, clinicians can identify patients who are at an increased risk for higher levels of morning fatigue and prescribe interventions to improve this devastating symptom.

Author Affiliations: School of Nursing, Yale University (Dr Wright), New Haven, Connecticut; School of Medicine, Stanford University (Dr Dunn), Palo Alto, California; School of Nursing, University of California (Drs Paul, Cooper, Miaskowski, and Kober), San Francisco; School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; School of Medicine, University of California (Dr Levine), San Francisco; and Mount Sinai Medical Center (Dr Hammer), New York, New York.

This study was funded by the National Cancer Institute (NCI; CA134900). Dr Miaskowski was supported by a grant from the American Cancer Society and NCI (CA168960). Dr Wright was funded by the National Institute of Nursing Research (T32NR008346).

The authors have no conflicts of interest to disclose.

Correspondence: Kord M. Kober, PhD, Department of Physiological Nursing, University of California, 2 Koret Way – N631Y, San Francisco, CA 94143-0610 (

Accepted for publication April 13, 2018.

Online date: July 18, 2018

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