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A Test for Psychobiologic Entropy Model on Cancer Related Fatigue among Patients with Solid Tumors

Chang Hee Oh1, Hyunyoung Park2, Ji Suk Lee2, Ja Yun Choi3
Korean Journal of Adult Nursing 2016;28(1):1-12.
Published online: February 29, 2016

1Chonnam National University Hwasun Hospital, Hwasun

2Department of Nursing, Honam University, Gwangju

3College of Nursing, Chonnam National University · CRINS, Gwangju, Korea

Corresponding author: Choi, Ja Yun College of Nursing, Chonnam National University, 5 Hak-dong, Dong-gu, Gwangju 501-746, Korea. Tel: +82-62-530-4943, Fax: +82-62-225-3307, E-mail: choijy@chonnam.ac.kr
• Received: September 25, 2015   • Accepted: February 9, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to test a Winningham's psychobiologic entropy model (PEM) on cancer related fatigue (CRF) among patients with solid tumors.
  • Methods
    Participants consisted of 213 patients with solid tumors recruited from December, 2012 through June, 2013, in a university hospital, in Hwasun, South Korea. Primary symptoms, adjustment, physical activity, status of nutrition and fatigue were measured using structured questionnaires. Collected data were analyzed using SPSS 21.0 and AMOS 21.0 programs.
  • Results
    The modified model tested provided a reasonable fit to the data (x2=65.80 [df=30, p<.001], TLI=.92, CFI=.95, RMSEA=.08, SRMR=.07). Primary symptoms (dyspnea, anxiety, depression and insomnia) had direct positive effects on CRF. Adjustment and status of nutrition showed indirect negative effects on CRF. However, the impact of physical activity was not significant. These variables explained 49.2% of the variance of CRF among solid tumor patients.
  • Conclusion
    The findings demonstrate that the tested model explain some CRF among solid tumor patients and warrant future research considering the cancer-related clinical factors of the given population.
  • Key Words: Carcinoma; Fatigue; Causality
Figure 1.
Hypothetical model from the Winningham's psychobiological-entropy model.
kjan-28-1f1.jpg
Figure 2.
Path diagram for the modified model.
kjan-28-1f2.jpg
Table 1.
Descriptive Statistics of the Observed Variables (N=202)
Variables Range M±SD Skewness Kurtosis
Diarrhea - 0.63±1.52 2.88 8.25
Pain 0~10 1.86±2.62 1.20 0.17
Dyspnea 1~5 0.43±1.07 2.51 5.52
Nausea/vomiting 0~4 0.33±0.63 2.51 6.71
Anxiety 0~3 0.71±0.57 0.74 -0.06
Depression 0~3 1.01±0.63 0.41 -0.50
Feelings of social isolation 1~5 2.42±0.72 0.26 -0.24
Insomnia 0~4 1.06±0.90 0.94 0.17
Nutritional status 1~4 1.96±0.99 0.86 0.46
Hemoglobin - 11.64±1.63 -0.26 0.00
Adjustment 1~4 2.75±0.47 -0.42 -0.22
Fighting spirit 1~4 2.34±0.51 -0.74 0.91
Hopeless 1~4 2.66±0.69 -0.31 -0.26
Fatalistics 1~4 2.36±0.76 -0.18 -0.72
Anxious preoccupation 1~4 2.57±0.65 -0.30 -0.01
Physical activity 1~3 1.59±0.63 0.61 -0.58
Fatigue 0~10 3.34±2.39 0.44 -0.78
Fatigue level 0~10 4.00±2.54 0.13 -1.01
Fatigue impact 0~10 3.01±2.59 0.56 -0.77
Table 2.
Goodness of Model Fit Indices (N=202)
Model df x2 (p) TLI CFI RMSEA SRMR
Criterion ≥.00 Low (≥.05) ≥.90 ≥.90 ≤.08 ≤.08
Hypothetical model 31 164.18 (＜.001) .71 .80 .15 .16
Modified model 30 65.80 (＜.001) .92 .95 .08 .07

TLI=Tuker-Lewis index; CFI=comparative fit index; RMSEA=root mean square error of approximation; SRMR=standardized root mean square residual.

Table 3.
Effects of Predictive Variables in the Modified Model (N=202)
Endogenous variables Exogenous variables β (p) SE CR (t-value) SMC SDE (p) SIE (p) STE (p)
Primary symptoms Biological energy -.28 (＜.001) ) .04 -4.02 .311 -.28 (.001) - -.28 (.001)
Adaptive energy -.42 (＜.001) ) .06 -5.35   -.42 (.003) - -.42 (.003)
Physical activity Biological energy .05 (.511) .05 0.66 .053 .05 (.511) .06 (.005) .11 (.144)
Adaptive energy -.05 (.595) .08 -0.53   -.05 (.587) .09 (.010) .05 (.559)
Primary symptoms -.23 (.019) .12 -2.34   -.23 (.012) - -.23 (.012)
Fatigue Biological energy - - - .490 - -.20 (.001) -.20 (.001)
Adaptive energy - - -   - -.29 (.003) -.29 (.003)
Primary symptoms .69 (＜.001) ) .34 9.85   .69 (.003) .01 (.165) .70 (.003)
Physical activity -.06 (.313) .23 -1.01   -.06 (.261) - -.06 (.261)

β=standardized regression weights; SE=standard errors; CR=critical ratios; SMC=squared multiple correlations; SDE=standardized direct effects; SIE=standardized indirect effects; STE=standardized total effects.

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    Citations to this article as recorded by  
    • Pre-post analysis of a social capital-based exercise adherence intervention for breast cancer survivors with moderate fatigue: a randomized controlled trial
      Sue Kim, Yun Hee Ko, Yoonkyung Song, Min Jae Kang, Hyojin Lee, Sung Hae Kim, Justin Y. Jeon, Young Up Cho, Gihong Yi, Jeehee Han
      Supportive Care in Cancer.2020; 28(11): 5281.     CrossRef

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    A Test for Psychobiologic Entropy Model on Cancer Related Fatigue among Patients with Solid Tumors
    Korean J Adult Nurs. 2016;28(1):1-12.   Published online February 29, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.1.1
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    • Citation for the content below
    A Test for Psychobiologic Entropy Model on Cancer Related Fatigue among Patients with Solid Tumors
    Korean J Adult Nurs. 2016;28(1):1-12.   Published online February 29, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.1.1
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    A Test for Psychobiologic Entropy Model on Cancer Related Fatigue among Patients with Solid Tumors
    Image Image
    Figure 1. Hypothetical model from the Winningham's psychobiological-entropy model.
    Figure 2. Path diagram for the modified model.

    Figure 1.

    Figure 2.

    A Test for Psychobiologic Entropy Model on Cancer Related Fatigue among Patients with Solid Tumors

    Descriptive Statistics of the Observed Variables (N=202)

    Variables Range M±SD Skewness Kurtosis
    Diarrhea - 0.63±1.52 2.88 8.25
    Pain 0~10 1.86±2.62 1.20 0.17
    Dyspnea 1~5 0.43±1.07 2.51 5.52
    Nausea/vomiting 0~4 0.33±0.63 2.51 6.71
    Anxiety 0~3 0.71±0.57 0.74 -0.06
    Depression 0~3 1.01±0.63 0.41 -0.50
    Feelings of social isolation 1~5 2.42±0.72 0.26 -0.24
    Insomnia 0~4 1.06±0.90 0.94 0.17
    Nutritional status 1~4 1.96±0.99 0.86 0.46
    Hemoglobin - 11.64±1.63 -0.26 0.00
    Adjustment 1~4 2.75±0.47 -0.42 -0.22
    Fighting spirit 1~4 2.34±0.51 -0.74 0.91
    Hopeless 1~4 2.66±0.69 -0.31 -0.26
    Fatalistics 1~4 2.36±0.76 -0.18 -0.72
    Anxious preoccupation 1~4 2.57±0.65 -0.30 -0.01
    Physical activity 1~3 1.59±0.63 0.61 -0.58
    Fatigue 0~10 3.34±2.39 0.44 -0.78
    Fatigue level 0~10 4.00±2.54 0.13 -1.01
    Fatigue impact 0~10 3.01±2.59 0.56 -0.77

    Goodness of Model Fit Indices (N=202)

    Model df x2 (p) TLI CFI RMSEA SRMR
    Criterion ≥.00 Low (≥.05) ≥.90 ≥.90 ≤.08 ≤.08
    Hypothetical model 31 164.18 (＜.001) .71 .80 .15 .16
    Modified model 30 65.80 (＜.001) .92 .95 .08 .07

    TLI=Tuker-Lewis index; CFI=comparative fit index; RMSEA=root mean square error of approximation; SRMR=standardized root mean square residual.

    Effects of Predictive Variables in the Modified Model (N=202)

    Endogenous variables Exogenous variables β (p) SE CR (t-value) SMC SDE (p) SIE (p) STE (p)
    Primary symptoms Biological energy -.28 (＜.001) ) .04 -4.02 .311 -.28 (.001) - -.28 (.001)
    Adaptive energy -.42 (＜.001) ) .06 -5.35   -.42 (.003) - -.42 (.003)
    Physical activity Biological energy .05 (.511) .05 0.66 .053 .05 (.511) .06 (.005) .11 (.144)
    Adaptive energy -.05 (.595) .08 -0.53   -.05 (.587) .09 (.010) .05 (.559)
    Primary symptoms -.23 (.019) .12 -2.34   -.23 (.012) - -.23 (.012)
    Fatigue Biological energy - - - .490 - -.20 (.001) -.20 (.001)
    Adaptive energy - - -   - -.29 (.003) -.29 (.003)
    Primary symptoms .69 (＜.001) ) .34 9.85   .69 (.003) .01 (.165) .70 (.003)
    Physical activity -.06 (.313) .23 -1.01   -.06 (.261) - -.06 (.261)

    β=standardized regression weights; SE=standard errors; CR=critical ratios; SMC=squared multiple correlations; SDE=standardized direct effects; SIE=standardized indirect effects; STE=standardized total effects.
    Table 1. Descriptive Statistics of the Observed Variables (N=202)

    Table 2. Goodness of Model Fit Indices (N=202)

    TLI=Tuker-Lewis index; CFI=comparative fit index; RMSEA=root mean square error of approximation; SRMR=standardized root mean square residual.

    Table 3. Effects of Predictive Variables in the Modified Model (N=202)

    β=standardized regression weights; SE=standard errors; CR=critical ratios; SMC=squared multiple correlations; SDE=standardized direct effects; SIE=standardized indirect effects; STE=standardized total effects.

    Table 1.

    Table 2.

    Table 3.

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