Prediction of evening fatigue severity in outpatients receiving chemotherapy: less may be more

Kord M. Kober, Ritu Roy, Anand Dhruva, Yvette P. Conley, Raymond J. Chan, Bruce Cooper, Adam Olshen, Christine Miaskowski

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
13 Downloads (Pure)


Background: Fatigue is the most common and debilitating symptom experienced by oncology patients undergoing chemotherapy. Little is known about patient characteristics that predict changes in fatigue severity over time. Purpose: To predict the severity of evening fatigue in the week following the administration of chemotherapy using machine learning approaches. Methods: Outpatients with breast, gastrointestinal, gynecological, or lung cancer (N = 1217) completed questionnaires one week prior to and one week following administration of chemotherapy. Evening fatigue was measured with the Lee Fatigue Scale (LFS). Separate prediction models for evening fatigue severity were created using clinical, symptom, and psychosocial adjustment characteristics and either evening fatigue scores or individual fatigue item scores. Prediction models were created using two regression and three machine learning approaches. Results: Random forest (RF) models provided the best fit across all models. For the RF model using individual LFS item scores, two of the 13 individual LFS items (i.e. ‘worn out’, ‘exhausted’) were the strongest predictors. Conclusion: This study is the first to use machine learning techniques to predict evening fatigue severity in the week following chemotherapy from fatigue scores obtained in the week prior to chemotherapy. Our findings suggest that the language used to assess clinical fatigue in oncology patients is important and that two simple questions may be used to predict evening fatigue severity.

Original languageEnglish
Pages (from-to)14-32
Number of pages19
JournalFatigue: Biomedicine, Health and Behavior
Issue number1
Publication statusPublished - 2021
Externally publishedYes


  • cancer
  • chemotherapy
  • Fatigue
  • machine learning
  • patient-reported outcomes
  • predictive model
  • symptoms


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