Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy  Fay Wright, RN, PhD, Gail D'Eramo Melkus, EdD, C-NP, Marilyn Hammer, PhD, DC, RN, Brian L. Schmidt, DDS, MD, PhD, M. Tish Knobf, RN, PhD, Steven M. Paul, PhD, Frances Cartwright, RN, PhD, Judy Mastick, RN, MS, Bruce A. Cooper, PhD, Lee-May Chen, MD, Michelle Melisko, MD, Jon D. Levine, MD, PhD, Kord Kober, PhD, Bradley E. Aouizerat, MAS, PhD, Christine Miaskowski, RN, PhD  Journal of Pain and Symptom Management  Volume 50, Issue 2, Pages 163-175 (August 2015) DOI: 10.1016/j.jpainsymman.2015.02.015 Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 a) Piecewise model of mean evening fatigue scores for six assessment points over two cycles of chemotherapy. b) Spaghetti plot of individual evening fatigue trajectories for a random sample of 30% of the total sample (n = 175) over two cycles of chemotherapy. LFAP = Lee Fatigue Scale Evening severity score. Journal of Pain and Symptom Management 2015 50, 163-175DOI: (10.1016/j.jpainsymman.2015.02.015) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 a–e) The adjusted change curves for evening fatigue that were estimated based on differences in ethnicity (i.e., ethnicity identified as white or nonwhite), education (i.e., less education/more education calculated as one SD above and below the mean), having children at home (i.e., yes or no), functional status (i.e., lower KPS score/higher KPS score calculated as one SD above and below the mean KPS score), and cancer diagnosis (breast, gynecological [GYN], or lung cancer vs. Gastrointestinal [GI]). KPS = Karnofsky Performance Status. Journal of Pain and Symptom Management 2015 50, 163-175DOI: (10.1016/j.jpainsymman.2015.02.015) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 3 a–b) The adjusted change curves for evening fatigue that were estimated based on the differences in depressive symptoms (lower CES-D score/higher CES-D score calculated as one SD above and below the mean CES-D score) and sleep disturbances (lower GSDS score/higher GSDS calculated as one SD above and below the mean GSDS score). c) The modest effects of the evening fatigue score at enrollment (lower fatigue/higher fatigue calculated as one SD above the mean evening Lee Fatigue Scale score) are plotted. CES-D = Center for Epidemiological Studies-Depression; GSDS = General Sleep Disturbance Scale. Journal of Pain and Symptom Management 2015 50, 163-175DOI: (10.1016/j.jpainsymman.2015.02.015) Copyright © 2015 American Academy of Hospice and Palliative Medicine Terms and Conditions