Lower Functional Status, Higher Comorbidity Burden, and Higher Levels of Stress Are Associated With Worse Joint Evening Fatigue and Depressive Symptom Profiles in Outpatients Receiving Chemotherapy

Abstract

Significance: Evening fatigue and depressive symptoms are associated with several negative outcomes for patients with cancer. However, the contribution of BOTH fatigue and depressive symptoms to patient outcomes remains unknown. This study identified subgroups of patients with distinct joint evening fatigue AND depressive symptom profiles and evaluated for differences in demographic and clinical characteristics, levels of stress (i.e., global, cancer-specific, and cumulative life) and resilience, and the severity of common symptoms.

Methods: Outpatients (n = 1334) completed the Lee Fatigue Scale and Center for Epidemiological Studies-Depression scale six times over two cycles of chemotherapy. Demographic and clinical characteristics, stress and resilience, and other common symptoms were assessed at enrollment. Joint evening fatigue and depressive symptom profiles were identified using latent profile analysis. Profile differences were assessed using parametric and nonparametric tests.

Results: Five profiles were identified (i.e., Low Evening Fatigue and Low Depression [Both Low: 20.0%], Moderate Evening Fatigue and Low Depression [Moderate Fatigue and Low Depression: 39.3%], Increasing and Decreasing Evening Fatigue and Depression [Both Increasing–Decreasing: 5.3%], Moderate Evening Fatigue and Moderate Depression [Both Moderate: 27.6%], High Evening Fatigue and High Depression [Both High: 7.8%]). Compared to the Both Low and Moderate Fatigue and Low Depression classes, the Both Moderate and Both High classes were less likely to be married, more likely to report depression, had a lower functional status, and had worse comorbidity profile. Both Moderate and Both High classes had higher levels of global, cancer-specific, and cumulative life stress and lower resilience.

Conclusions: Multiple risk factors for higher levels of evening fatigue AND depressive symptoms during chemotherapy were identified, including lower functional status, higher comorbidity burden, lower levels of resilience, and higher global, cancer-specific, and cumulative life stress. These risk factors may be used to identify patients at greatest risk for poorer outcomes and to prescribe interventions to decrease these symptoms.