UCSF

Context. Energy conservation strategies are recommended in a number of clinical practice guidelines to manage fatigue associated with cancer and its treatments. However, little is known about changes in energy levels in oncology patients undergoing cancer treatment.

Objectives. An evaluation was done to identify variations in the trajectories of morning and evening energy levels and to determine which demographic, clinical, and symptom characteristics predicted initial levels as well as the trajectories of morning and evening energy.

Methods. Outpatients with breast, gastrointestinal, gynecological, and lung cancer, who were undergoing chemotherapy (CTX), completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Morning and evening energy levels were evaluated using the energy subscale of the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives.

Results. A large amount of inter-individual variability was found in both the morning and evening energy trajectories. A piecewise model fit the data best. Patients who lived alone, had child care responsibilities, had a lower functional status, did not exercise on regular basis, had lower hemoglobin levels, as well as lower attentional function, higher trait anxiety and higher sleep disturbance reported lower morning energy levels at enrollment. Variations in the trajectories of morning energy were associated with a higher body mass index, as well as higher levels of morning energy and higher sleep disturbance scores. In terms of evening energy, patients who were female, White, had lower functional status, and had lower attentional functional and higher sleep disturbance scores reported lower evening energy levels at enrollment. Evening energy levels at enrollment were associated with changes in evening energy over time.

Conclusion. Patients undergoing CTX experience decrements in both morning and evening energy. Different modifiable and non-modifiable characteristics were associated with decrements in morning and evening energy levels. These modifiable characteristics can be used to design intervention studies to increase energy levels in these patients.