Side Effects

The main side effects for children being treated for cancer or blood disorders are as a result of chemotherapy and radiotherapy. Chemotherapy programs for children have become more intensive and complex over time. This means there is a range of predictable, but temporary, side effects that occur during treatment. These include:

• Nausea/vomiting, diarrhoea
• Hair loss (alopecia)
• Increased risk of infection
• Mouth ulcers
• Bone marrow suppression

Chemotherapy is the name for a group of drugs designed to kill cancer cells throughout the body. It is most effective on those cells that are rapidly dividing and fast growing. Therefore, it kills cancer cells but also damages normal cells with similar characteristics. For example, it damages the hair follicles (resulting in hair loss), the lining of the mouth and gut (causing mouth ulcers, nausea/vomiting) and bone marrow suppression.

Bone Marrow Suppression

• When the chemotherapy drugs interfere with the ability of the bone marrow to make healthy blood cells it is common for blood counts to drop significantly 7-10 days after treatment.

• During this time, there is an increased risk of serious infection (due to low numbers of healthy white cells), anaemia (due to low numbers of red blood cells) and bleeding (due to low numbers of platelets necessary for clotting.) For more information click here.

• If your child has recently received chemotherapy and they develop a temperature when they are at home, they must be seen by a doctor and have a full blood count and blood cultures taken as a matter of urgency. For more information click here.

• For the more intensive chemotherapy treatments, the bone marrow growth factor G-CSF (Granulocyte Stimulating Factor) is often given via injection, to make the white cell count recover more quickly to reduce the risk of infection.

Supportive Management – includes:

• Managing infections – prompt intervention with intravenous antibiotics if necessary.
• Blood transfusions
• Managing nausea and vomiting with preventative anti-nausea medication (eg Ondansetron).
• Nutritional support – Intravenously, nasogastrically or orally.
• Mouth care – to prevent mucositis, ulcers, infections and bleeding.
• Pain management.
• Preventing and managing metabolic complications.

Viral Infections

Children receiving treatment are commonly exposed to viral illnesses (eg the common cold) and mostly the body’s natural defense system can handle these infections. However, some viral illnesses such as chicken pox and shingles, can be more serious in children with cancer and require immediate treatment.

Chicken Pox is highly contagious and children who are immunocompromised are at increased risk of getting severe chicken pox, with the virus not only affecting the skin but also the lungs (pneumonia), liver (hepatitis) and brain (meningitis).

Important – if your child develops symptoms of chicken pox, or has been exposed to chicken pox, or anyone in your family gets chicken pox, you should contact your treating doctor immediately.

If your child has contact with someone with chicken pox:

It is recommended that he/she receives Varicella Zoster Immunoglobulin (ZIG) which is effective in preventing chicken pox if given within 72 hours of exposure. Your child will also be in an isolation room if they need to be in Hospital for treatment or appointments. This is to reduce the risk of spreading the virus to other immunocompromised children.