Having chemotherapy

What happens after treatment?

The most important side effect that your child’s treatment causes is bone marrow suppression. This means that the normal activity of the bone marrow is reduced. The bone marrow’s purpose is to produce cells. These cells are white cells, red cells and platelets.

After a course of chemotherapy these cells are not produced in normal amounts for several days. Usually the blood count falls gradually following each course and is at it is lowest around 12 to 15 days after the start of a course. It then recovers in a further 7 to 10 days. This means the courses of medicine can, if necessary be given every 21 to 28 days.

What about infection?

When the blood count is low, your child is at risk of becoming unwell from an infection. This can be life-threatening and must be treated quickly with antibiotics.

If you are concerned your child is unwell then it is important to contact the ward for advice. The most likely infection that your child may get is from common germs found on their skin and in their gut. It is safe for your child to mix with other people and go to school in between their courses of treatment, if they feel well enough.

What should I look out for and what should I do?

Temperature

The usual sign of a potential infection is a high temperature but the temperature could also be low. If you child’s temperature reaches 38 degrees Celsius, please telephone the ward for advice. Please do not give your child Calpol or other paracetamols, until you have spoken to the ward.

If your child’s white blood cell count is below 0.5 and they have a temperature above 38 degrees Celsius, then they will need to be admitted to a ward. They will need to have blood tests and blood cultures taken, and also have intravenous (IV) antibiotics for a minimum of 48 hours.

If your child is still unwell, they may need to have more blood tests and blood culture tests taken.

Bleeding and bruising

If your child has purple blood spots (that look like bruises) on their skin, an unresolved nose bleed or gum bleed, then you need to telephone the ward for advice. It is likely that they will need to attend the ward for a full blood count and may need a platelet transfusion.

Being sick and has diarrhoea

If your child is being sick or has diarrhoea, and is not keeping any fluids down, then you should contact the ward for advice. They may need to attend the ward for intravenous (IV) anti-sickness drugs and have fluids to stop dehydration.

Pale, low energy, breathless and has headaches

If your child is pale, breathless, lethargic and complaining of headaches, then they may be anaemic. This is because they have a low red blood cell count so they may need a blood transfusion. However if their blood count is low and your child is well then a transfusion is not usually needed. Please phone the ward for advice if you are concerned or not sure.

If there is anything else worrying you about your child, then please phone the ward day or night for assistance.

If your child becomes seriously unwell please call 999 for an ambulance so that your child can receive immediate medical attention and be taken to the nearest Emergency Department.

Chicken pox

Chicken pox is an acute and highly infectious disease which is transmitted directly by personal contact or droplet spread.

Fluid-filled spots may appear on your child’s face and scalp, and spread around their body. After 3 to 4 days the spots will begin to dry out and scab over but new fluid-filled spots may continue to appear. The infectious period is from 2 days before the spots appear until all the spots are dry and scabbed.

If your child has had chicken pox then they will usually have antibodies and these give themselves enough protection against further infection. We test your child’s blood at the time of diagnosis to check their antibody status. If your child has antibodies you should not need to worry about contacts with chicken pox or shingles.

If your child does not have antibodies and has a close contact with a person who definitely has chicken pox, or who develops it within the following 4 days, then please contact the ward so we can decide if treatment is needed. It may be needed for your child to have a 3 week course of medicine to reduce the chance of chicken pox developing.

It is not necessary to keep your child away from school if you think there may be chicken pox in school, particularly if your child has antibodies. Close contact is where your child has been in the same room for more than 20 minutes with a person that has chicken pox or develops it shortly after your child was with them.

Shingles

This is the reactivation of the virus which initially causes chicken pox. Fluid-filled spots usually appear in 1 area of the body. This is commonly the head, neck or torso and your child may experience a lot pain.

Shingles is infectious and may cause chicken pox in children who have not had this infection. It does not cause a problem to anyone who has had chicken pox.

Measles

Measles is an acute viral illness transmitted by droplet infection. Common signs include spots in the mouth, runny nose, runny eyes, cough, rash and a temperature. Cases of measles are going up because many children do not have their childhood vaccinations.

If your child has had measles or the measles vaccination, then they should be immune. Being in contact with a person with measles should not have any problems.

If your child has not has the measles vaccination, and then comes into contact with a person has measles or who develops measles after a few days, then please contact the ward. Your child may need to have a doctor check if they have a measles rash. If your child is not immune then we may advise a measles vaccination.

It is not necessary to keep your child away from school if measles is in school.

Other infections

Contact with other infections such as German measles, mumps, scarlet fever, coughs and colds and so on, do not need specific treatment but in general, contact with anyone who is unwell with an infection is best avoided.

Vaccinations and immunisations

During your child’s treatment and for a period of 6 months after their treatment, your child should not be given live vaccinations. This is because your child’s immune system may not respond well enough.

6 months after completing their treatment, your child’s immune system should be able to respond correctly and the will be able to have live vaccination if needed.

All children, at any stage of treatment may have the meningitis C vaccine.

Siblings and those close to your child can have the MMR immunisation.

However, siblings and and those close to your child should not be given the oral ‘live’ polio vaccine. The inactivated or ‘dead’ vaccine should be used instead.

Mouth care

The inside of the mouth is very sensitive and can be damaged by chemotherapy and radiotherapy. Harmless bacteria that are normally in the mouth can cause infections and soreness, particularly after chemotherapy. Practising mouth care can help reduce your child’s risk of infections or soreness in their mouth.

Regular mouth care is an essential part of your child’s treatment. The health of the mouth influences nutrition, comfort, and protects against infection.

How to do effective mouth care

Your child should do mouth care at least 2 times per day. Use a soft nylon toothbrush to gently clean the teeth with regular toothpaste or chlorhexidine gel. Do not mix chlorhexidine gel with regular toothpaste.

Corsodyl (chlorhexidine gel) can be used with a toothbrush. These products are aimed at reducing plaque. If you use your own toothpaste please leave 60 minutes between this and the chlorhexidine gel or mouthwash.

If they have used Corsodyl toothpaste then thoroughly swish, gargle and spit 10mls Corsodyl (chlorhexidine) mouthwash for 30 seconds if possible. Please wait for 60 minutes before eating or drinking.

If their mouth is sore use 10mls of Difflam mouthwash or spray preparation. This will help to numb their mouth as it is mildly antiseptic.

Apply yellow soft paraffin (Vaseline) to dry or cracked lips.

We believe that parents and carers are the best people to look after their child’s mouth. If you find this difficult please ask for help.

Dentists

Your child should not have any dental treatment from your family’s dentist during their treatment. The dentists from the Charles Clifford Dental Hospital come to our clinics, and will see your child whilst they are at Sheffield Children’s hospital and do any work needed.

Diet and appetite

Many children having chemotherapy have a poor appetite and will not eat well. This naturally causes anxiety and many parents and carers worry that their child will not be strong enough to cope with their treatment. Please try to not worry about this. Getting into arguments with your child about eating is stressful for everyone. We will monitor your child’s weight and if we have concern about their food and drink, we can supplement nutrition in a few ways.

Our dietician can discuss with you how you can improve the nutritional content of what your child will eat. There are also several supplements that can be added to drinks and foods to make them more nutritious. If your child cannot eat enough then sometimes we may use a nasogastric tube (NG) to supplement or replace what your child is taking by mouth. Sometimes we may have to use intravenous (IV) total parental nutrition (TPN) if your child cannot cope with an NG tube.

Feeling and being sick

During chemotherapy many children may feel sick and be sick. Diarrhoea can also be a problem for some children. Anti-sickness drugs can be given and can be very helpful at preventing these unpleasant symptoms.

Hair loss

Due to the chemotherapy treatments your child may lose their hair. This does not happen for every child and depends on which chemotherapy drugs your child is receiving. Some children may like to cover their heads with a hat or bandana. Wigs are available on prescription and from The Little Princess Trust. Please speak to the ward or clinic staff if your child would like a one.

Details

Diagnosis:

Consultant:

POON or NOON nurse:

Clic Sargent social worker:

Please download the Oncology and Haematology discharge info checklist.