Care : Jurnal Ilmiah Ilmu Kesehatan
Vol 14, No 2 (2026): EDITION JULY 2026

Associations Between Hemoglobin, Insomnia, Nausea, Cancer-Related Fatigue in Chemotherapy Outpatients: Implications for Clinical Nursing Management

Hendra Dwi Cahyono (Nursing Departement, Faculty of Health Science, Universitas dr. Soebandi , Jember, East Java, Indonesia)
zahra saad (Nursing Departement, Faculty of Nursing, Mahsa University, Malaysia)
Ina Martiana (Nursing Departement, Faculty of Health Science, Universitas dr. Soebandi , Jember, East Java, Indonesia)
Anita Fatarona (Nursing Departement, Faculty of Health Science, Universitas dr. Soebandi , Jember, East Java, Indonesia)
Fitri Kusumasa (Departement, Faculty of Health Science, Universidade of Dilli, Dili, Timor Leste)



Article Info

Publish Date
22 Jul 2026

Abstract

Cancer-related fatigue (CRF) is one of the most prevalent and distressing symptoms experienced by patients with cancer during chemotherapy. CRF is multidimensional in nature and is often associated with biological factors and co-occurring symptoms such as anemia, insomnia, and nausea and vomiting. Objective: This study aimed to examine the associations between hemoglobin levels, insomnia, nausea and vomiting, and cancer-related fatigue among patients undergoing outpatient chemotherapy. A quantitative observational study with a cross-sectional design was conducted. A total of 111 patients receiving outpatient chemotherapy were recruited using consecutive sampling. Cancer-related fatigue was assessed using the Fatigue Assessment Scale (FAS), insomnia was measured using the Insomnia Severity Index (ISI), and nausea and vomiting were assessed using the Rhodes Index of Nausea, Vomiting, and Retching (RINVR). Hemoglobin levels were obtained from patients’ medical records. Data were analyzed descriptively and using bivariate Spearman’s correlation analysis. The mean hemoglobin level was 11.43 ± 2.05 g/dL. The mean scores for cancer-related fatigue, insomnia, and nausea and vomiting were 30.12 ± 9.06, 16.77 ± 5.28, and 7.92 ± 7.45, respectively. Spearman’s correlation analysis revealed a significant negative association between hemoglobin levels and cancer-related fatigue (r = ?0.293; p = 0.002). In contrast, insomnia (r = 0.277; p = 0.003) and nausea and vomiting (r = 0.278; p = 0.003) were positively and significantly associated with cancer-related fatigue. Cancer-related fatigue among chemotherapy outpatients is significantly associated with hemoglobin levels, insomnia, and nausea and vomiting. Routine monitoring of hemoglobin levels, along with systematic screening for sleep disturbances and nausea, is recommended to support more effective nursing interventions for managing cancer-related fatigue in outpatient chemotherapy settings.

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Journal Info

Abbrev

care

Publisher

Subject

Health Professions Nursing Public Health

Description

Care : Jurnal Ilmiah Ilmu Kesehatan ISSN 2527-8487(online), ISSN 2089-4503(cetak), adalah jurnal peer-review yang menerbitkan artikel tentang praktik, teori, dan penelitian di semua bidang kesehatan dan keperawatan.Scope jurnal terdiri dari keperawatan,kesehatan,kesehatan ...