Chemotherapy For Childhood Cancer

Key points about chemotherapy for childhood cancer

• chemotherapy treatment uses anti-cancer medicines (drugs) to treat cancer by stopping cells from growing or by destroying cells
• your child may have several types of chemotherapy
• each type of chemotherapy medicine stops cell growth or destroys cells in a different way
• how your child receives chemotherapy will depend on the type of cancer they have and the chemotherapy medicines that work best for that type of cancer

What is chemotherapy?

Chemotherapy treatment uses anti-cancer medicines to treat cancer by stopping cells from growing or by destroying cells.

Your child may have several types of chemotherapy because each type of chemotherapy medicine stops cell growth or destroys cells in a different way.

When chemotherapy destroys cancer cells, it can also damage healthy cells. This damage can cause side effects. Often, the side effects get better or go away once the chemotherapy treatment ends. Different medicines have different side effects. Each child can react differently to the same chemotherapy drug.

How will my child receive chemotherapy?

Your child may receive chemotherapy treatment:

• by mouth
• into a vein
• into a muscle
• into the spinal fluid

Your child will have chemotherapy in one or more of these ways. How your child receives chemotherapy will depend on the type of cancer they have and the chemotherapy medicines that work best for that type of cancer.

What medicines will my child have during chemotherapy?

Your child's treatment plan

Soon after your child's cancer diagnosis, your child's healthcare team will give you a treatment plan, often called a treatment protocol.

This will have details of the treatment and the names of the medicines the doctors will use. It will also explain how and when the medical team will give the medicines.

Medicine information sheets

Your child's healthcare team will also give you information sheets about the medicines that your child will have and the possible side effects. The information sheets will also tell you if you need to protect yourself and your family from contact with these medicines. This is because some medicines stay in wee (urine), poo (faeces) and blood up to 48 hours after chemotherapy treatment ends.

Chemotherapy usually happens in cycles

In most cases, chemotherapy happens in cycles. A cycle is a period of chemotherapy treatment followed by a rest period. The rest period allows your child's body time to build healthy new cells before the next treatment. For example, your child may have chemotherapy for 1 week and then have 2 weeks of rest. These 3 weeks make up 1 cycle.

Your child's healthcare team will give you information about your child's chemotherapy schedule. They will also list all the chemotherapy medicines that your child will have.

See patient information sheets for a range of chemotherapy drugs

Are there any safety measures I need to take while my child is having chemotherapy?

After your child has chemotherapy, their body sometimes gets rid of small amounts of the medicines in body fluids, including blood, wee, poo or vomit. The amount will vary depending on the kind of medicine they have.

• get rid of wee, poo and vomit in the toilet - flush twice with the lid down to avoid splashing
• put soiled disposable nappies in a plastic bag and put them in the rubbish
• do a separate wash of other dirty things like cloth nappies, linen and clothing - use lots of detergent and water
• make sure you wash your hands thoroughly after handling wee, poo and vomit
• wear gloves when handling wee, poo and vomit if you are pregnant or breastfeeding

Read more about childhood cancer treatments

What are the side effects of chemotherapy?

Many chemotherapy medicines cannot tell the difference between normal cells and cancer cells. These medicines affect all cells that divide rapidly. The damage to normal cells may lead to side effects. Different chemotherapy medicines cause different side effects.

Since tamariki (children) respond to chemotherapy differently, some tamariki will experience more side effects than others. Your child's healthcare team will manage the side effects as they develop to keep your child as comfortable as possible. Because normal cells can repair themselves, the side effects are nearly always temporary.

Chemotherapy medicines most often affect the normal cells in the:

• bone marrow (where blood is produced), causing fewer blood cells than normal - this is known as a low blood count
• digestive tract (mouth, stomach, bowels or intestines, rectum) causing nausea, vomiting or mouth and gut ulcers
• hair follicles, causing hair loss

What are some things I can do when my child is having chemotherapy?

Tell your child's doctor or nurse if you think the medicine is causing other side effects.

It can help to keep all the following in one place:

• all the medicine information sheets for your child - they list the possible side effects of your child's medicines
• your child's treatment plan (treatment protocol)
• any other printouts about your child's treatments

Will chemotherapy hurt my child?

Oral chemotherapy

Oral chemotherapy is just like taking any other medicine by mouth. It does not hurt but if your child does not like medicines, the nurse or hospital play specialist will give you some hints to help make it easier for them.

You may be able to give chemotherapy to your child by mouth at home. If this is an option, the nursing staff or pharmacist will teach you about this.

Injections into a muscle

A doctor or nurse may inject the medicine into your child's muscle (intramuscular injection). This may sting.

Injections under the skin

A doctor or nurse may give an injection under your child's skin (subcutaneous injection). If this happens, your child's nurse will first put a numbing (anaesthetic) cream on your child's skin. This will make the area feel numb. Either a nurse will put the cream on your child's skin, or show you how to do it yourself.

Injections into the spinal cord fluid

If your child needs an injection into the fluid around the spinal cord (intrathecal injection), this will happen under general anaesthetic so your child will be asleep and will not feel anything.

Injections into a vein

If your child has an external catheter, a nurse will put the medicine into the tubing so there is no skin prick.

If your child has an internal catheter, you or a nurse can put an anaesthetic cream on your child's skin over the port. This will numb your child's skin before the nurse puts the needle in.

Will my child need to have chemotherapy treatment in hospital?

Not always. Your child can have chemotherapy tablets or liquid (suspension) at home.

Your child may receive some kinds of chemotherapy at an outpatient clinic or day-stay unit of the hospital. Your child may receive the medication:

• as a quick injection from a syringe or
• in a bag of fluid over several hours

Some chemotherapy is complex. If your child needs this kind of chemotherapy, they will need to go to hospital. Your healthcare team will discuss this with you and it will be in the treatment plan (treatment protocol).

Read more about childhood cancer