Chemotherapy for children
Chemotherapy is one way your child may be treated for a brain tumour. Chemotherapy uses ‘cytotoxic’ (anti-cancer) drugs to destroy tumour cells by interrupting or stopping their growth.
Chemotherapy can be used on its own, with radiotherapy, or it may be used before or after surgery.
How does chemotherapy work?
Our bodies are made up of cells that divide as part of their natural cycle to reproduce and repair themselves. If this process is disrupted, the cells can begin to grow in an uncontrolled way, creating a lump of cells called a tumour.
Chemotherapy drugs disturb the dividing process of both tumour cells and healthy cells. However, healthy cells are more able to repair themselves, whilst tumour cells are more likely to die.
Chemotherapy for children
Jake can tell you and your child all about chemotherapy for children in this short animation.
Why is chemotherapy given?
Your child’s health team will carefully consider the best course of treatment for your child. This will depend on several factors, including your child’s exact tumour type, their age and size and their general health. You should feel free to ask as many questions as you wish.
Depending on your child’s type of brain tumour, their age, and general health, chemotherapy may be given:
- before surgery – to shrink a tumour to make it easier to operate on
- after surgery – to prevent a tumour from returning
- to treat a tumour that has returned
- to shrink a tumour that cannot be operated on
- to prevent further growth of a tumour
- before, during or after radiotherapy.
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How is treatment given?
Your child may be given chemotherapy in one of a number of ways:
For children, chemotherapy is usually injected into the vein via a ‘central line’.
A central line is a thin, hollow, flexible tube, made from silicone rubber, which is inserted into a vein and fed through the vein into a large central blood vessel in the chest, close to the heart. (This is why it is called a central line.)
Your child will be under anaesthetic when the tube is inserted, so it will not be painful.
The central line will stay in place for several months whilst your child receives chemotherapy treatment.
The central line (tube) carries chemotherapy into the body. It can be used for injections of a single dose of a drug. Or it can be attached to a drip, which is used for the slow delivery of a larger volume of fluid containing the drug.
There are different types of line and the type of line your child has depends on factors, such as their tumour type and also their age.
Different IV chemotherapy tubes have different names and your child may have one of the following:
- Central line (central venous catheter) is inserted near the collarbone and runs to a large vein near the heart. The other end of the line will then be tunnelled under the skin to reach the exit site, which is usually in the chest area. (The exit site is the place where the tube comes out of the body)
- Portacath (an implantable port) may be inserted into the upper chest or under the arm and runs to a large vein in the lower neck.
- PICC line (Peripherally Inserted Central venous Catheter) is inserted in to a large vein on the arm near to where the elbow bends. It runs to a large vein near the heart.
There are advantages and disadvantages of each type of line.
Your child may have chemotherapy in the form of tablets or liquids, although this is less common, as some types of chemotherapy drugs cannot be absorbed by the stomach, so cannot be taken orally.
Chemotherapy given orally is absorbed in the stomach and carried around their body in the blood stream to reach the cancer cells.
If your child is given a tablet or liquid form of chemotherapy:
- give the medication exactly as prescribed. This will make sure it is most effective
- do NOT crush the tablets unless you are advised to
- touch the medication as little as possible. You and your child should wash your hands as soon as possible after doing so. Whoever is giving the drugs should wear disposable medical gloves
- pregnant mothers should be extremely careful when handing chemotherapy medication or bodily fluids that may contain chemotherapy drugs
Your child’s health team can give you more information.
Some children may have difficulty swallowing the chemotherapy tablets, as they can be quite large, or they may be fearful of taking tablets in general. This is not uncommon and they should know that they are not alone in their difficulties.
Care should be taken not to make medication a battle, as this can increase the anxiety levels of your child further.
If you are having difficulty getting your child to take their chemotherapy drugs, talk to your child’s health team about ways of supporting your child and reducing their anxiety.
A pharmacist can also advise on other ways the tablets can be given. Or, depending on your child’s age, they could practice with small sweets, such as tic tacs or similar.
Your child’s health team may be able to refer your child to a psychologist or psychiatrist, who can help your child with coping strategies and help them prepare for treatment. Alternatively, they may recommend a therapist who can help with relaxation and visualisation techniques.
Very occasionally, chemotherapy may be injected into the fluid surrounding the brain and spine (cerebrospinal fluid). This is called intraventricular (brain) or intrathecal (spine) chemotherapy.
Chemotherapy can also be put into the brain as a wafer or gel at the time of surgery, but this is only licensed for use in adults, so is very rarely used in children
How long will chemotherapy last?
Treatment plans vary enormously and your child’s chemotherapy will be carefully planned and tailored to them individually.
These variations in treatment depend on many factors including the type of tumour your child has, your child’s age, the amount of surgical removal achieved (where relevant), and your child’s general health.
As a result, it could vary from daily chemotherapy for a while, as a day case in hospital, to being admitted to the ward for several days every 2 – 3 weeks.
The overall length of chemotherapy treatment also varies widely, and can be from between approximately 3 – 12 months or even longer. The duration and frequency will be explained by your child’s health team.
Is there a maximum number of times my child can have chemotherapy?
This very much depends on the type of chemotherapy drug.
Some have to be limited because of ‘cumulative toxicity’. This means that with each dose, the side effects that affect the body and its functions increase, so the total dose has to be limited.
Other chemotherapy drugs will be stopped if they are not working, if an unacceptable toxicity (side-effect) occurs, or if your child can no longer tolerate the drug.
Will my child need to stay in hospital?
Chemotherapy is often given as an outpatient treatment, which means that your child won’t usually have to stay in hospital overnight, but in certain circumstances they may need to. Your child’s doctor will talk to you about this before treatment begins.
Generally speaking, if your child is given chemotherapy in tablet or liquid form, they will be able to take this at home.
If they are having chemotherapy by injection, they would usually have this in a chemotherapy clinic as an outpatient.
Why does my child have to have rest periods?
Rest periods between treatment sessions give your child’s body a chance to recover from any side-effects and give healthy cells an opportunity to repair themselves.
Having chemotherapy in a series of cycles (treatments and rest periods) also enhances its effectiveness.
This is because chemotherapy only destroys cells that are in the process of dividing. Cancer cells are not dividing all the time, there will be times when they are resting.
So the first time your child is given chemotherapy it won’t work on the cells that are resting. The second time they are given it, the cells that were resting the first time may now be dividing and the chemotherapy will destroy them and so on.
What side-effects might my child have?
Side-effects vary from child to child and according to the drugs they have been given. As chemotherapy temporarily acts on healthy cells as well as tumour cells, it may cause some unpleasant, short-term side-effects. Find out more about the side-effects of chemotherapy.
How do you know if chemotherapy has worked?
During and after treatment, your child will be monitored using scans to check how well the treatment is working, e.g. for any changes to their tumour.
This can be through the use of scans to see whether the tumour is shrinking. Usually MRI scans (Magnetic Resonance Imaging) are used though sometimes it can be by CT scan (Computerised Tomography).
Another way of detecting whether the tumour is responding to treatment is via ‘tumour markers’ in the blood. A tumour marker is a product that is secreted by tumour cells.
Decreasing levels of tumour markers suggest that the tumour is shrinking. However, only a few types of brain tumour produce measurable markers. Please speak to your child’s health team for more information.
If chemotherapy doesn’t work
Although your child’s treatment plan will be carefully developed by healthcare professionals to be as effective as possible while having the fewest risks or side-effects, sometimes chemotherapy may not work. This can be worrying, but just because one treatment hasn’t worked, it doesn’t mean others won’t.
Find out more about what happens when treatment doesn’t work.
Find out more about Chemotherapy for children in the full fact sheet -including information about how to care for your child's central line.
Find out more about Chemotherapy for children in the full fact sheet – Clear print version, designed to RNIB guidelines – including information about how to care for your child's central line.
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