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Chemotherapy

Is chemotherapy harsher than radiation?
Does my child need to be inpatient for chemotherapy?
My child is terrified of needles. How are we going to get through chemotherapy?
Why is my doctor concerned about the 5 pounds that my child has lost since starting chemotherapy?
Why isn’t my child allowed to take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) while she’s on chemotherapy?


Is chemotherapy harsher than radiation?
Generally, more side effects are seen with chemotherapy than radiation therapy during the period of cancer treatment. A new class of chemotherapy, known as targeted therapy, which acts more precisely on cancer cells by focusing on the molecular and cellular changes related to malignancy, is being developed and is significantly easier to tolerate. However, its effectiveness for pediatric brain tumors has not yet been determined. This is an active area of brain tumor research.

Most types of chemo work by attacking the fast-growing cancer cells in the body. This includes those in the hair roots – leading to hair loss or thinning – and healthy blood cells. A drop in red blood cells (anemia), platelets (thrombocytopenia) and a type of white cells called neutrophils (neutropenia) can occur and may need to be treated with blood transfusions and medications that stimulate the bone marrow.

Neutropenia is a serious side effect because it puts your child at risk for infections that will require urgent treatment. The good news is that blood levels frequently return to normal soon after treatment, which may last for a few months or more than a year, typically in cycles with rest periods in between.

Nausea, mouth sores, diarrhea and appetite loss are common side effects that can be prevented or eased with drugs. Hearing loss and kidney damage are more serious ones that need to be diagnosed promptly through regular screening.

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Does my child need to be inpatient for chemotherapy?
It depends on the type of treatment. For standard chemotherapy involving multiple potent medications, your child will be inpatient for a few days at the start of each cycle, where any side effects or complications can be carefully monitored. Other types of chemotherapy can be taken in a hospital clinic or even at home. Chemotherapy can be delivered intravenously, via a subcutaneous or intramuscular injection, or by mouth in pill or liquid form.

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My child is terrified of needles. How are we going to get through chemotherapy?
Numbing cream (Lidocaine) can be applied prior to blood draws and injections. Chemotherapy drugs are usually delivered by a catheter (equivalent to a “long term IV”). Those commonly used include a PICC line (peripherally inserted central catheter), which is a long plastic catheter placed into one of the veins of the arms.

Central venous catheters such as port-a-cath and tunneled catheter (known by their brand names: Broviac, Groshong and Hickman) are placed under the skin on the chest.

All types of catheters have advantages and disadvantages in terms of maintenance, insertion and removal. These catheters are removed after they are no longer needed for chemotherapy or other IV medications.

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Why is my doctor concerned about the five pounds that my child has lost since starting chemotherapy?
It’s not unusual for children on treatment to lose weight, especially during chemotherapy when nausea can be persistent and food may taste different. But during chemotherapy your child needs calories not only for healing and to increase stamina, but to create the new cells needed to help the immune system fight infection.

Your hospital’s registered dietician can advise you on ways to supplement your child’s nutrition and prevent weight loss. Adding ice cream or calorie-rich smoothies might do the trick, but some children may be disgusted by foods they once craved.

Prescription drugs can sometimes be effective in stimulating appetite, but may come with undesirable side effects. In some cases a nasogastric tube, which carries food and medicine to the stomach through the nose, can be the best way to get the nutrients children need to see them through treatment.

Conversely, corticosteroids, like Prednisone and Decadron, which are prescribed to treat brain swelling, can cause rapid appetite increase and weight gain.

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Why isn’t my child allowed to take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) while on chemotherapy?
When your child’s white blood count is low during chemo (neutropenia), he or she will be susceptible to severe infections. When an immune system is compromised, these infections usually require intravenous antibiotics that need to be started urgently (even before that infection is diagnosed). Fever may be the first indication that your child is developing an infection, so it’s critical that it isn’t masked by pain medications that also prevent fevers.

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