Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Drs Lin and Xiao), Atlanta, Georgia; School of Nursing, Duke University (Dr Bailey), Durham, North Carolina; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of California San Francisco (Drs Paul, Cooper, Kober, and Miaskowski); School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California San Francisco (Drs Levine and Miaskowski).
Cancer Nurs. 2024;47(1):E28-E37. doi: 10.1097/NCC.0000000000001148. Epub 2022 Dec 11.
Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life.
Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics.
Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses.
Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function.
Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers.
Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
胃肠道癌症患者在化疗期间经历疲劳严重程度的昼夜变化，这会降低他们的功能状态和生活质量。
本研究旨在确定具有不同晨晚间疲劳特征的患者亚组，并评估这些亚组在人口统计学、临床、应激和症状特征方面的差异。
胃肠道癌症患者（n=405）在 2 个化疗周期中完成了 6 次问卷调查。使用 Lee 疲劳量表评估疲劳严重程度的昼夜变化。采用潜在剖面分析识别具有明显晨晚间疲劳特征的患者亚组。采用参数和非参数分析评估亚组在入组时的人口统计学、临床、应激和症状特征方面的差异。
确定了两个亚组，即低晨高晚疲劳（即低-中度，60.0%）和高晨高晚疲劳（即双高，40.0%）。与低-中度组相比，双高组更年轻、女性、未婚、失业，缺乏规律运动。此外，他们有育儿责任，年收入较低，功能状态较差，合并症负担较重，报告有贫血和抑郁。双高组患者报告的焦虑、抑郁症状、睡眠障碍、疼痛和压力水平更高，而能量和认知功能水平更低。
研究结果为胃肠道癌症患者更高水平的晨晚间疲劳共病提供了新的见解。
临床医生可以利用这些信息来识别高风险患者，并制定个性化的症状管理干预措施。
