The study confirmed that fatigue is an important problem among RT patients. Resilience turned out to powerfully predict the patients' fatigue at least early in RT. This result is in line with other studies, showing resilience to be an important psychological predictor of QoL and coping in cancer patients. On the other hand, resilience seems to have little influence on treatment related fatigue during RT.

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Object This 25-year follow-up study was performed on 120 children with hypertensive hydrocephalus to evaluate the influence of the early prophylactic implantation of the Integra antisiphon device (ASD, Integra Neurosciences Ltd.) on the rate of proximal shunt obstructions and the frequency of symptomatic slit ventricle syndrome (SVS). The adaptability of the ASD to growth, proper positioning of the ASD as a necessity for its successful performance, and the 3 phases of SVS development are discussed. Method Since 1978, the ASD has consistently been implanted either at the time of primary shunt insertion (66 neonates, mean follow-up 11 years) or during revisions of preexisting shunts (54 children, mean follow-up 11.8 years). The complication rate among the 54 children before ASD implantation (mean follow-up 8.3 years) was compared with that among all 120 patients once an ASD had been inserted. Shunt complications were documented as ventricular catheter, distal catheter, and infectious complications. Results The study revealed a significant long-term reduction in ventricular catheter obstructions and hospitalizations due to intermittent intracranial hypertension symptoms (symptomatic SVS) after both primary and secondary ASD implantation. Data in the study suggest that the high rate of ventricular catheter obstruction in pediatric shunt therapy is caused by hydrostatic suction induced by differential-pressure valve shunts during mobilization of the patient and that the development of a SVS can be traced back to this constant suction, which causes chronic CSF overdrainage and ventricular noncompliance. Recurrent ventricular catheter obstruction and SVS can be prevented by prophylactic supplementation of every shunt system with an ASD. Conclusions To inhibit chronic hydrostatic suction, to prevent overdrainage and proximal shunt obstruction, and to avoid SVS and thus improve the patient's quality of life, the prophylactic implantation of an ASD in every pediatric hydrocephalus shunt is recommended.