19.2.8Fatigue

•Fatigue can manifest itself in many ways, for example, as weakness, exhaustion, drowsiness, or weariness. It is a transient side effect of chemoor radiotherapy. Fatigue may also be a direct consequence of the disease as such. After cessation of treatment, strength gradually returns

•When, how long, and how badly side effects occur will differ between individuals and depends on the type of treatment

19.2.8.1Causes

•Pressure from tumor and metastases

•Unbalanced production of cytokines, pathological collection of metabolites, bone marrow infiltration (anemia)

•Chemotherapy as such via hypoplasia of normal tissue

•Infection, tumor-associated fever

•Inadequate nutrition: deficient in protein and calories or undernourishment

•Lack of sleep

•Physical exhaustion

•Pain

•Other drugs, for example, analgesics, antidepressants, neuroleptics, sedatives, cough medicine

•Electrolyte deficiency, hypokalemia

•Radiotherapy

•Fear, nervousness, depression, boredom during hospitalization

•Uncertainty, uncertain prognosis, psychological stress caused by workup of disease

•Financial and family problems

19.2.8.2 Symptoms

• Tiredness, dizziness, headache, weakness, decrease in muscle strength

• Every person experiences these symptoms and their sequelae differently. Fatigue for instance is a subjective sensation and is described by those affected as an insurmountable, persistent feeling of exhaustion

• The consequences of fatigue are multidimensional and impair the quality of life of patients

19.2.8.3 Prophylactic Care

•The child needs to ration activity, not giving up on usual activities, but adapting them to preserve energy (e.g., playgroup, kindergarten, or school attendance), setting priorities, reducing stress

•Generating strength by sufficient sleep, vitamin and iron supplementation, relaxation exercises, coping with stress

•Drinking sufficient amounts in order to stay well hydrated

•Distraction through visiting friends, playing games, but not strenuous hobbies

•Exercise in fresh air