Abstract
Purpose
Pain, depression, distress, fatigue, and sleep disturbance are common symptoms in
oncology patients, but little data are available that examine the trajectories of
these symptoms during chemotherapy (CTX). The purposes of this study were to examine
the trajectories of these symptoms during the first six cycles of CTX and to determine
whether individual characteristics predicted the trajectories of these symptoms.
Methods
Oncology outpatients (n = 118) with newly diagnosed lung cancer, colorectal cancer,
or lymphoma rated symptoms using an electronic patient care monitor system. Pain,
fatigue, and sleep disturbance were rated on 0–10 numeric rating scales; depression
and distress were evaluated using scales converted to normalized T scores. Latent
growth curve analyses (LGCA) examined for intra- and inter-individual differences
in the trajectories of these five symptoms during the six cycles of CTX.
Results
Symptoms were present at the initiation of CTX (p < 0.0001) for all symptoms (p < 0.05). Distress (p = 0.03) and pain (p = 0.02) intensity decreased significantly over the six cycles of CTX. Advanced disease
and a higher number of comorbidities predicted higher fatigue at baseline (p = 0.02 and 0.01 respectively). A diagnosis of lung cancer predicted an increasing
intensity of fatigue during CTX (p = 0.04). Concurrent radiation therapy predicted more intense pain over time (p = 0.03).
Conclusions
While symptom trajectories were highly variable in patients undergoing initial CTX,
the majority of the symptom intensity scores decreased over time. However, patients
with lung cancer, those with a higher number of comorbidities, and those with advanced
disease experienced more intense fatigue and sleep disturbance over time.
Keywords
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References
- Cancer Facts and Figures 2008.(Retrieved February 27, 2008, accessed from)2008
- Symptoms experience: a concept analysis.Oncology Nursing Forum. 2003; 30: 601-606
- New paradigms for treating elderly patients with cancer: the comprehensive geriatric assessment and guidelines for supportive care.Journal of Supportive Oncology. 2003; 1: 30-37
- Symptom cluster research: conceptual, design, measurement, and analysis issues.Journal of Pain and Symptom Management. 2006; 31: 85-95
- Comparative fit indexes in structural models.Psychological Bulletin. 1990; 107: 238-246
- Significance tests and goodness of fit in the analysis of covariance structure.Psychological Bulletin. 1980; 88: 588-606
- Structural equation modeling with small samples: test statistics.Multivariate Behavioral Research. 1999; 34: 181-197
- Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy.Oncology Nursing Forum. 1998; 25: 51-62
- Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study.Oncology Nursing Forum. 2000; 27: 1443-1448
- Sleep wake disturbances in people with cancer and their caregivers: state of the science.Oncology Nursing Forum. 2005; 32: E98-126
- Latent Curve Models: A Structural Equation Perspective.John Wiley & Sons, Hoboken, New Jersey2006
- Building dynamic models and theories to advance the science of symptom management research.Journal of Advanced Nursing. 2010; 66: 228-240
- Nurses’ repeat measurement of chemotherapy symptoms: feasibility, resulting information, patient satisfaction.Cancer Nursing. 2003; 26: 468-475
- Alternative ways of assessing model fit.in: K. A. B. J. S. L Testing Structural Equation Models. Sage, Newbury Park, CA1993: 136-162
- Patterns of symptom distress in adults receiving treatment for lung cancer.Journal of Palliative Care. 2002; 18: 150-159
- Fatigue and physical activity in patients undergoing hematopoietic stem cell transplantation.Oncology Nursing Forum. 2006; 33: 614-624
- The cancer care monitor: psychometric content evaluation and pilot testing of a computer administered system for symptom screening and quality of life in adult cancer patients.Journal of Pain and Symptom Management. 2003; 26: 1077-1092
- Symptom clusters in elderly patients with lung cancer.Oncology Nursing Forum. 2004; 31: 202-212
- A cluster of symptoms over time in patients with lung cancer.Nursing Research. 2003; 52: 393-400
- Treatment-related symptom clusters.Seminars in Oncology Nursing. 2006; 31: 142-151
- Cutoff criterion for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.Structural Equation Modeling. 1999; 6: 1-55
- Predictors of depressive symptomatology of geriatric patients with colorectal cancer: a longitudinal view.Supportive Care in Cancer. 2002; 10: 494-501
- Chemotherapy-Induced Neutropenia and the AIM Higher Initiative [Electronic Version].(Retrieved October 20, 2005 from)2005
- Gender differences in pain, fatigue, and depression in patients with cancer.Journal of the National Cancer Institute Monograph. 2004; 32: 139-143
- Fatigue patterns in Chinese patients receiving chemotherapy.European Journal of Oncology Nursing. 2001; 5: 60-67
- Statistical and substantive checking in growth mixture modeling: comment on Bauer and Curran (2003).Psychological Methods. 2003; 8 (369-377; discussion): 384-393
- MPlus User’s Guide.Fifth Edition. Muthen & Muthen, Los Angeles1998–2007
- NCCN practice guidelines for the management of psychological distress.Oncology (Williston Park). 1999; 13: 113-147
- Cancer and comorbidity: redefining chronic diseases.Cancer. 2000; 88: 653-663
- Chemotherapy and Biotherapy Guidelines.Oncology Nursing Press, Pittsburgh2009
- National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: pain, Depression, and Fatigue, July 15-17, 2002.Journal of the National Cancer Institute. 2003; 95: 1110-1117
- Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy.Scholarly Inquiry of Nursing Practice. 2000; 14 (275-290; discussion): 278-291
- Patterns of self-reported symptoms in pancreatic cancer in patients receiving chemoradiation.Journal of Pain and Symptom Management. 2007; 34: 244-252
- Fatigue in patients receiving chemotherapy: patterns of change.Cancer Nursing. 1998; 21: 17-30
- Correlates of symptom distress in women with lung cancer.Cancer Practice. 1993; 1: 21-28
- Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer.Chest. 2004; 125: 439-445
- Patterns of exercise and fatigue in physically active cancer survivors.Oncology Nursing Forum. 1998; 25: 485-491
- Daily fatigue patterns and effect of exercise in women with breast cancer.Cancer Practice. 2000; 8: 16-24
- Fatigue patterns observed in patients receiving chemotherapy and radiotherapy.Cancer Investigation. 2000; 18: 11-19
- A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate.Health Psychology. 2004; 23: 564-573
- Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms.Journal of Clinical Oncology. 2006; 20: 4485-4491
Article info
Publication history
Published online: January 20, 2011
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© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
