The trajectory of fatigue in adult patients with breast and ovarian cancer receiving chemotherapy

Judith K Payne
Oncology Nursing Forum 2002, 29 (9): 1334-40

PURPOSE/OBJECTIVES: To describe the trajectory of fatigue and determine the feasibility of exploring physiologic mechanisms of fatigue in adult patients receiving chemotherapy for breast and ovarian cancer.

DESIGN: Descriptive, longitudinal, repeated measures.

SETTING: Outpatient ambulatory cancer centers within two large, academic, teaching hospitals with overnight hospital stays in general clinical research centers.

SAMPLE: Seventeen adult participants with either early-stage breast or ovarian cancer receiving chemotherapy for the first time.

METHODS: Demographic questionnaire; Piper Fatigue Scale (PFS); hemoglobin, bilirubin, melatonin, and weight change were measured at baseline, three months, and approximately six months. PFS also was collected at three additional two-week nadir, post-treatment, measurement points. Descriptive statistics and repeated analysis of variance measures were used to analyze data.

MAIN RESEARCH VARIABLES: Fatigue, hemoglobin, bilirubin, melatonin, and presence of other comorbid disease.

FINDINGS: Subjective fatigue was experienced by the majority of patients receiving chemotherapy. It was irregular over time, intensified at three months, and continued after treatment ended. The physiologic trajectory of fatigue from baseline to three months indicated a significant change over time in hemoglobin in the breast cancer group (p = 0.02) and in nighttime melatonin levels for both breast and ovarian cancer groups (p = 0.03). Although not significant, daytime melatonin levels changed over time from baseline to six months.

CONCLUSIONS: Fatigue fluctuates during the course of chemotherapy treatment and does not cease after treatment ends. Preliminary findings suggest that fatigue mechanisms may have an undetermined physiologic basis.

IMPLICATIONS FOR NURSING: Assessment of cancer treatment-related fatigue must be ongoing, even after treatment ends. Findings suggest an awareness of the importance of understanding fatigue mechanisms to enable future testing of research-based interventions.

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