| Fatigue is the most prevalent and disturbing symptom in cancer patients; however, little research explains the correlates and predictors of fatigue. The purposes of this study were to describe the fatigue patterns in lymphoma patients undergoing autologous peripheral blood stem cell transplantation (APBSCT) and to examine the relationships among these fatigue patterns and the changes in the patterns of melatonin, depression, pain, nausea, hemoglobin level, total sleep time within 24 hours, and number of awakenings at night that contribute to the changes in fatigue during the baseline, chemotherapy and recovery periods. The conceptual framework of this prospective, descriptive, correlational, and repeated measures study is based on Piper's Integrated Fatigue Model. The sample included 26 lymphoma patients undergoing APBSCT, ages 19--71 years, Data collection included the Revised Piper Fatigue Scale, Single Fatigue Intensity Item, urine samples, Center for Epidemiologic Studies-Depression Scale, Numerical Pain Intensity Rating Scale, Nausea Severity Item, hemoglobin level, and sleep/wake parameters. Data analysis included descriptive statistics, RM-ANOVA, Friedman's RM-ANOVA, cosine regression, sleep analysis, Spearman correlations and Tobit regression. The major findings were that the total fatigue and the four fatigue dimension scores changed significantly over time, with the highest scores one week after transplantation. The highest correlations were between fatigue and depression, and occurred 2 days after transplantation (r = .620 to r = .952, p < .05), No significant correlations were found between fatigue and hemoglobin level at any time point, Total sleep within 24 hours and mean pain level were most predictive of fatigue and the four dimension scores over time. Depression, hemoglobin level, number of awakenings at night, and melatonin mean levels also contributed to fatigue. Findings of this study suggest the importance of routine clinical assessment of fatigue and the suggested correlates before initiation of and during chemotherapy, as well as during the recovery period. Greatest attention should be paid to the first week after transplantation. The results of this study could lead to the development of interventions to lessen the symptoms contributing to fatigue, and could consequently decrease fatigue. |
