Distinct Morning and Evening Fatigue Profiles in Patients With Gynecologic Cancers Receiving Chemotherapy

Oncol Nurs Forum. 2025 Feb 18;52(2):E35-E57. doi: 10.1188/25.ONF.E35-E57.

Abstract

Objectives: To identify distinct morning and evening fatigue profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, common symptoms, and quality-of-life outcomes.

Sample & setting: Outpatients with gynecologic cancers (N = 233) were recruited before their second or third cycles of chemotherapy at four cancer centers in San Francisco Bay and New York.

Methods & variables: The Lee Fatigue Scale was completed six times over two cycles of chemotherapy in the morning and in the evening. Latent profile analysis was used to identify distinct morning and evening fatigue profiles.

Results: Four distinct morning and two distinct evening fatigue classes were identified. Common risk factors for morning and evening fatigue included younger age, higher body mass index, lower functional status, and higher comorbidity burden. Patients in the worst morning and evening fatigue classes reported higher levels of anxiety, depression, and sleep disturbance; lower levels of energy and cognitive function; and poorer quality of life.

Implications for nursing: Clinicians can use this information to identify higher-risk patients and develop individualized interventions for morning and evening fatigue.

Keywords: chemotherapy; evening fatigue; gynecologic cancer; morning fatigue; quality of life.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents* / adverse effects
  • Antineoplastic Agents* / therapeutic use
  • Circadian Rhythm*
  • Fatigue* / chemically induced
  • Fatigue* / etiology
  • Female
  • Genital Neoplasms, Female* / complications
  • Genital Neoplasms, Female* / drug therapy
  • Genital Neoplasms, Female* / nursing
  • Humans
  • Middle Aged
  • Quality of Life
  • Risk Factors
  • San Francisco

Substances

  • Antineoplastic Agents