Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity
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ORIGINAL ARTICLE
Higher levels of stress and different coping strategies are associated with greater morning and evening fatigue severity in oncology patients receiving chemotherapy Fay Wright 1 & Kord M. Kober 2 & Bruce A. Cooper 2 & Steven M. Paul 2 & Yvette P. Conley 3 & Marilyn Hammer 4 & Jon D. Levine 5 & Christine Miaskowski 2,5,6 Received: 20 September 2019 / Accepted: 9 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose A cancer diagnosis and associated treatments are stressful experiences for most patients. Patients’ perceptions of stress and their use of coping strategies may influence fatigue severity. This study extends our previous work describing distinct profiles of morning (i.e., Very Low, Low, High, and Very High) and evening (i.e., Low, Moderate, High, and Very High) fatigue in oncology patients by evaluating for differences in stress and coping strategies among these fatigue classes. Methods This longitudinal study evaluated for changes in morning and evening fatigue in oncology patients (n = 1332) over two cycles of chemotherapy (CTX). Patients completed measures of cumulative exposure to stressful life events (SLEs) (i.e., the Life Stressor Checklist-Revised), general stress (i.e., Perceived Stress Scale [PSS]), cancer-specific stress (i.e., Impact of Event ScaleRevised [IES-R]), and coping strategies (i.e., Brief Cope). Differences among the latent classes were evaluated using analyses of variance, Kruskal-Wallis, or chi-square tests. Results Patients in both the Very High morning and evening fatigue classes reported higher numbers of and a higher impact from previous SLEs and higher PSS scores than the other fatigue classes. The IES-R scores for the Very High morning fatigue class met the criterion for subsyndromal PTSD. Patients in the Very High evening fatigue class used a higher number of engagement coping strategies compared with the Very High morning fatigue class. Conclusions Our findings suggest that interventions to reduce stress and enhance coping warrant investigation to decrease fatigue in patients undergoing CTX. Keywords Morning fatigue . Evening fatigue . Chemotherapy . Cumulative life stress . Coping . Stress . Cancer
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05303-5) contains supplementary material, which is available to authorized users. * Christine Miaskowski chris.miaskowski@ucsf.edu 1
Rory Meyers College of Nursing, New York University, New York, NY, USA
2
School of Nursing, University of California, San Francisco, CA, USA
3
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
4
Dana Farber Cancer Center, Boston, MA, USA
5
School of Medicine, University of California, San Francisco, CA, USA
6
Department of Physiological Nursing, University of California, 2 Koret Way – N631F, San Francisco, CA 94143-0610, USA
Introduction A cancer diagnosis and associated treatments are stressful experiences for most patients [1]. Stress initiates a cascade of pa
