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Higher Levels of Stress Are Associated with a Significant Symptom Burden in Oncology Outpatients Receiving Chemotherapy


Background: A cancer diagnosis and associated treatments, as well as the uncertainty of the

disease course, are stressful experiences for most patients. However, little information is

available on the relationship between stress and symptom burden. The study purpose was to

evaluate for differences in the severity of fatigue, lack of energy, sleep disturbance, and

cognitive function, among three groups of patients with distinct stress profiles.

Methods: Patients receiving chemotherapy (n=957) completed measures of general, cancer

specific, and cumulative life stress and symptom inventories. Latent profile analysis was used to

identify subgroups of patients with distinct stress profiles.

Results: Three distinct subgroups of patients were identified (i.e., Stressed (39.3%), Normative

(54.3%), Resilient (5.7%)). For cognitive function, significant differences were found among the

latent classes (Stressed

evening fatigue, compared to the Normative and Resilient classes, the Stressed class reported

higher severity scores. Compared to the Normative and Resilient classes, the Stressed class

reported low levels of morning energy. Compared to the Normative class, the Stressed class

reported lower levels of evening energy.

Conclusions: Consistent with our a priori hypothesis, patients in the Stressed class had the

highest symptom severity scores for all four symptoms and all of these scores were above the

clinically meaningful cutoffs for the various instruments.

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