Chemotherapy for Children

What is chemotherapy for a child?

Chemotherapy (chemo) is the use of medicines to treat cancer or kill cancer cells. Chemotherapy has been used for many years. It’s one of the most common treatments for many types of cancer. The groups of cancer therapy medicines work in different ways to fight cancer cells. For example, some interfere with the ability of cancer cells to grow or reproduce. It’s common for cancer to be treated with more than one medicine at a time. Chemo may be used alone or used with other treatments, such as radiation or surgery.

Why might my child need chemotherapy?

Your child may need chemo to:

Treat a certain type of cancer
Decrease the size of a tumor before surgery
Help other treatment work better, such as radiation
Reduce pain, or other symptoms, and improve quality of life

What are the risks of chemotherapy for a child?

Chemo can work very well to treat cancer. But while these medicines kill cancer cells, they can also damage healthy cells. The damage to healthy cells causes side effects. Your child's cancer healthcare provider (oncologist) will keep track of your child very closely for side effects. They will prescribe medicines or other treatments and give you instructions to help reduce the side effects.

There are many chemo medicines. Some are used more often to treat cancer in children. Side effects of chemo vary by the dosage and medicine used. There will be more side effects if more than one chemo medicine is given. Ask your child's provider what side effects you can expect, when to report to them, and how to manage them.

Side effects of busulfan (given by mouth or IV) can include:

Abnormal heartbeat, heart failure
Confusion, dizziness, headache, fever, feeling tired, seizures
Hair loss (alopecia), acne, rash, itchiness
Belly (abdominal) pain, nausea, vomiting, diarrhea, liver problems
Decrease in blood cell counts (myelosuppression)
Joint and muscle pain
Trouble breathing, bleeding, asthma, collapsed lung
Allergic reaction
Infections

Side effects of carboplatin (given by IV) can include:

Damage to nervous system (neurotoxicity)
Damage to hearing (ototoxicity)
Hair loss (alopecia)
Belly (abdominal pain), diarrhea, nausea, vomiting, mouth inflammation (mucositis)
Decrease in blood cell counts (myelosuppression) or bleeding
Severe allergic-type reaction
Infection

Side effects of cisplatin (given by IV) can include:

Damage to nervous system (neurotoxicity)
Damage to hearing (ototoxicity)
Nausea and vomiting
Decrease in blood cell counts (myelosuppression)
Severe damage to kidneys (renal toxicity)
Severe allergic-type reaction

Side effects of cyclophosphamide (given by mouth or IV) can include:

Feeling tired
Hair loss (alopecia)
Belly (abdominal) pain, nausea, vomiting, diarrhea, mouth inflammation (mucositis)
Decrease in blood cell counts (myelosuppression)
Bladder damage (bladder toxicity)
Reproductive hormone changes
Infections

Side effects of cytarabine (given by IV or into the spinal canal) can include:

Infection of sac surrounding heart (pericarditis)
Damage to nervous system (neurotoxicity)
Eye inflammation (conjunctivitis)
Fever, headache, tiredness
Hair loss (alopecia), rash, skin ulcers, itchiness
Belly (abdominal) pain, nausea, vomiting, and diarrhea
Mouth sores
Liver problems
Decrease in blood cell counts (myelosuppression)
Kidney problems
Trouble breathing (dyspnea)
Severe allergic-type reaction
Severe infection (sepsis)

Side effects of daunorubicin or doxorubicin (given by IV) can include:

Damage to heart muscle (myocardial toxicity)
Heart failure
Feeling tired
Severe local tissue injury
Decreased blood supply to tissue (necrosis) at IV site
Hair loss (alopecia)
Belly (abdominal) pain, nausea, vomiting, diarrhea, mouth inflammation (mucositis)
Decrease in blood cell counts (myelosuppression)
Other cancers

Side effects of etoposide or teniposide (given by IV) can include:

Low blood pressure (hypotension)
Problems with the nerves in the arms and legs (peripheral neuropathy)
Feeling tired
Hair loss (alopecia)
Belly (abdominal) pain, nausea, vomiting, diarrhea, inflammation in mouth (mucositis)
Damage to liver (hepatotoxicity)
Severe decrease in blood cell counts (myelosuppression)
Severe allergic-type reaction

Side effects of hydroxyurea (given by mouth) can include:

Dizziness
Feeling tired
Headache
Seizures
Hair loss (alopecia)
Skin ulcers, nail changes, redness (erythema), death of tissue (gangrene)
Nausea, vomiting, diarrhea, inflammation in mouth (mucositis)
Liver failure
Decrease in blood cell counts (myelosuppression)
Cancer affecting white blood cells (leukemia)
Asthma
Trouble breathing (dyspnea)

Side effects of L-asparaginase (given by IV or as an injection) can include:

Pain, swelling, or redness
IV may cause itchiness, rash
Trouble breathing (dyspnea)
Tightening of airway (bronchospasm)
Severe allergic-type reaction

Side effects of mercaptopurine (given by mouth) can include:

Fever
Feeling tired
Hair loss (alopecia)
Rash
Belly (abdominal) pain
Inflammation in mouth (mucositis)
Liver damage (hepatotoxicity)
Gallbladder and pancreas problems
Damage to kidneys (renal toxicity)
Decrease in blood cell counts (myelosuppression)
Damage to lungs (pulmonary fibrosis)
Infections

Side effects of methotrexate (given by mouth, IV, injection, or into the spinal canal) can include:

Blood clots (thromboses)
Fluid around heart (pericardial effusion)
Infection of sac surrounding heart (pericarditis)
Severe damage to nervous system (neurotoxicity)
Dizziness, feeling tired, headache
Hair loss (alopecia), acne, rash, ulcers, itchiness
Inflammation of bowel (enteritis), bleeding, nausea, vomiting, inflammation of mouth (mucositis)
Liver failure, cirrhosis of liver
Decrease in blood cell counts (myelosuppression)
Severe kidney disease, renal failure
Blood in urine (hematuria)
Pain with or trouble urinating (dysuria)
Fertility problems
Bleeding
Joint and muscle pain
Severe allergic-type reaction
Cancer of lymphatic system (lymphoma), infections, eye problems

Side effects of thioguanine (given by mouth) can include:

Nausea, vomiting
Decreased blood supply to intestines (intestinal necrosis), hole in intestines (intestinal perforation)
Decreased blood supply to liver (hepatic necrosis)
Damage to liver (hepatotoxicity)
Decrease in blood cell counts (myelosuppression)
Infections

Side effects of thiotepa (given by IV) can include:

Dizziness, feeling tired, fever, headache
Hair loss (alopecia), rash, skin inflammation (dermatitis), pain at site of IV
Belly (abdominal) pain, nausea, vomiting, diarrhea
Decrease in blood cell counts (myelosuppression), bleeding
Pain with or trouble urinating (dysuria)
Asthma
Bleeding
Severe allergic-like reaction

Side effects of topotecan (given by mouth or IV) can include:

Feeling tired
Fever, headache, pain
Hair loss (alopecia), rash
Belly (abdominal) pain, nausea, vomiting, diarrhea
Decrease in blood cell counts (myelosuppression)
Trouble breathing (dyspnea), pneumonia
Severe allergic-like reaction
Infections

Side effects of vincristine or vinblastine (given by IV) can include:

High blood pressure (hypertension)
Feeling tired
Hair loss (alopecia)
Trouble having bowel movements (constipation)
Decrease in blood cell counts (myelosuppression)
Bone and jaw pain
Tumor pain
Problems with nerves in the hands and feet (peripheral neuropathy)

How do I get my child ready for chemotherapy?

Before starting treatment, your child may have blood and imaging tests. They may have minor surgery to place a catheter or port. The catheter or port is used to deliver the chemotherapy medicines, other medicines, and to take blood samples. It prevents your child from having repeated needle sticks.

Getting your child ready for chemo depends on their age and developmental level. Try to:

Talk with your child with help from books and websites, such as the American Cancer Society .
Answer your child’s questions honestly.
Get support from your child's oncologist or nurse, or an expert in working with children and their families (child life specialist).

What happens during chemotherapy for a child?

Your child may have chemotherapy at a hospital (inpatient or outpatient), the oncologist's office, a cancer center or clinic, infusion center, or home. Your child may have treatment every day, every week, or every few weeks for a period of time. Treatment is given in cycles. This gives your child time to rest and recover between treatments.

Chemo can be given in different ways. The most common ones are:

Orally. This means it’s taken by mouth as a pill or liquid to swallow.
Into a vein by IV (intravenously). If your child doesn't have a catheter or port, the nurse or technician will put a needle into one of your child's veins with each treatment. It is removed after the treatment. The treatment may take a few hours.
As a shot (injection). The shot is given into a muscle or under the skin.
Intrathecal injection. This means the treatment will be injected into the fluid filled space that is located between thin layers of tissue that cover the brain and spinal cord. Only specific medications can be given this way.

When having chemotherapy:

Your child will be checked before, during, and after each treatment.
Your child’s vital signs, such as body temperature and blood pressure will be checked. Blood tests may also be done.
Your child may be given medicines and fluids to help prevent side effects.

What happens after chemotherapy for a child?

After treatment, your child may stay in the hospital to keep track of and manage side effects. Or your child may be able to go home. The nurse and healthcare provider will make sure there are no serious side effects or reactions. Your child may be able to take part in normal activities, such as school. Or they may not be able to do so, due to tiredness or other side effects. Make sure you’re aware of and prepared for possible side effects. Call your child's healthcare provider if your child has new or worse symptoms.

Next steps

Before you agree to the treatment, test, or procedure for your child make sure you know:

The name of the treatment, test, or procedure
The reason your child is having the treatment, test, or procedure
What results to expect and what they mean
The risks and benefits of the treatment, test, or procedure
When and where your child is to have the treatment, test, or procedure
Who will do the procedure and what that person’s qualifications are
What would happen if your child did not have the treatment, test, or procedure
Any alternative treatments, tests, or procedures to think about
When and how will you get the results
Who to call after the treatment, test, or procedure if you have questions or your child has problems
If there is a different number to call after office hours or on weekends and holidays
How much will you have to pay for the treatment, test, or procedure