Fatigue in Childhood Cancer

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Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.

Cancer-related fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion related to cancer and/or its treatment.

Cancer-related fatigue is different to other types of fatigue (such as when a healthy individual does not sleep or relax enough), because it interferes with an individual’s regular functioning, does not reflect their level of activity, and does not improve with rest.

Most individuals receiving cancer treatment experience fatigue; some cancer survivors also experience fatigue that can last for months and even years after treatment has finished.

 

Symptoms

Fatigue often negatively affects the overall physical, psychological, social, and economic well-being of an individual who has cancer. For some, it is slightly bothersome, while for others the experience can be overwhelming.

Fatigue may influence your child’s:

  • Ability to undergo treatment
  • Attitude toward the future
  • Daily activities
  • Feeling of well-being and sense of joy
  • Hobbies and other enjoyable activities
  • Job performance
  • Mood and emotions
  • Social relationships

 

Causes

Not all of the causes of cancer-related fatigue are well understood, and your child’s fatigue may be the result of more than one cause.

Fatigue could be as a result of living with constant pain; distress, depression, and anxiety; inability to sleep; inadequate nutrition; anaemia; the cancer treatments (chemotherapy, radiation therapy etc.); medications used to manage other side effects; or co-existing medical conditions.

It is for this reason that it is recommended that your child’s level of fatigue is evaluated when they are first diagnosed with cancer and assessed throughout treatment and into recovery.

An ongoing annual evaluation should be performed as well as any time that your child develops symptoms of fatigue.

This type of evaluation is generally part of a comprehensive screening called distress screening that evaluates your child’s emotional health and quality of life.

 

Diagnosis

In order to diagnose fatigue, your child’s doctor or healthcare team will look at various factors, including the history of the fatigue; when it started, when your child feels most tired, whether it has changed over time, what makes it better or worse and the level of fatigue experienced.

Your child may also be required to undergo tests to learn more about potential cancer-related causes of their fatigue or whether another health condition is affecting their level of fatigue, and may also have to give a blood sample.

 

Management/Treatment

Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.

The first step in managing fatigue is the treatment of any medical cause of fatigue or any condition that is contributing to fatigue, including:

Pain Management: Living with constant pain will make even the strongest person feel exhausted, let alone a small child. Many of the medications prescribed for the treatment of pain also cause drowsiness, sleepiness, and fatigue. Your child’s doctor/healthcare team can help you understand the pain management options available and give you information about common side effects of pain medications.

Depression, Anxiety, and Stress Management: Fighting the ravages of cancer and all that goes with it can be distressing to a child, and often leads to anxiety and increased feelings of exhaustion, which may complicate treatment. Managing stress and treating depression and anxiety usually makes a huge difference in a child’s level of fatigue.

Sleep Management: Stress, pain, and anxiety often interfere with a child’s ability to sleep through the night. Some medications may also change normal sleep patterns, and when a child is chronically tired, sleep may overtake them at different times of the day or evening. Not feeling refreshed by sleep or being unable to sleep more than one to two hours at a time can also contribute to feelings of exhaustion and will in all likelihood affect your child’s mood and ability to function normally.

Nutrition Management: Eating well and drinking enough fluids are very important to your child maintaining an adequate weight and to meeting their nutritional needs. If possible, consider talking with a nutrition counsellor or registered dietitian (RD) at your child’s oncology treatment centre. A counsellor will be able to give you helpful hints on providing a well-balanced diet for your child, as well as tips on how to get your child to eat when their taste is affected; they have no appetite, or are experiencing nausea and/or vomiting as a result of their treatments.

Anaemia Management: Many individuals with cancer develop anaemia, which is a decrease in the amount of circulating red blood cells. Anaemia may be caused by the cancer itself or the cancer-related treatments. People who develop anaemia report a feeling of extreme and overwhelming fatigue. Your child’s treatment for anaemia may include nutritional supplements, medications, and/or blood transfusions.

Medication Side-Effect Management: Many of the medications used to treat cancer also contribute to fatigue.

It is common for fatigue to appear:

  • A few days after Chemotherapy Treatment
  • A few weeks after beginning Radiation Treatment
  • After treatment with immunotherapy such as Interferon Alpha and Interleukin

Medications used to manage other side effects may also contribute to fatigue, such as those used to manage pain (see above).

Co-existing Medical Condition Management: Individuals with cancer who also have other health conditions such as heart problems, arthritis, lowered lung and kidney function, hormone problems, and nerve problems could find that those conditions are the cause of or may worsen their fatigue.

 

Tips for Coping with Fatigue

Apart from treating and managing the medical causes of fatigue, your child could also benefit from some lifestyle changes which could help them better cope with their fatigue:

 

Counselling and Therapy

Your child may find it beneficial to speak to a therapist or counsellor specifically trained to work with children with cancer, and could help them manage or reduce their fatigue.

Cognitive Behavioural Therapy or Behavioural Therapy is a specific type of counselling that can help your child reframe their thoughts about fatigue and improve poor coping skills and/or sleep problems that could be contributing to their fatigue.

 

Medications and Supplements

Certain medicines that make people feel more alert and awake may help your child to manage their fatigue better.

There are also various supplements on the market that may also help; ginseng and vitamin D have been touted as being beneficial, however there is still ongoing research to prove this medically.

Speak to your child’s oncologist/healthcare team before giving them any medications or supplements as they may interfere with medications prescribed by the doctor or with the cancer treatments.

 

Mind-Body Therapy

Many individuals with cancer benefit from mindfulness-based approaches such as yoga and acupuncture in managing cancer-related fatigue. Touch therapy, massage, music therapy, relaxation, reiki, and qigong may also be beneficial for reducing fatigue.

These are all either touch-based or gentle therapies, and should be safe for your child, but as with any other alternative/complementary treatment/therapy, discuss this with your child’s doctor first.

 

Physical Activity

Staying physically active can help relieve your child’s cancer-related fatigue, as can increasing their activity level. It is important to start slowly and gradually increase their activity levels. Walking is good exercise and is generally considered safe for most children with cancer and most survivors.

Once your child is healthy enough for physical activity, try to build up to 120 minutes of moderate activity, such as fast walking, cycling, or swimming per week plus two to three strength training sessions per week.

Discuss the appropriate level and types of physical activity that would be best for your child with their doctor/healthcare team before starting any exercise regime, especially if your child has a higher risk of injury due to the cancer, its treatment, or other health conditions.

The doctor may suggest that your child work with a physical therapist or exercise specialist who can find the best ways to increase or maintain their physical functioning.

 

 

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