Childhood cancer treatments

Most children diagnosed with cancer in the UK will immediately be referred to one of 21 hospitals that are specialist centres for children’s cancer treatment. Doctors at the specialist centre will confirm the diagnosis and plan the child’s cancer treatment. Some of the later treatment may be given at the family’s local hospital under the guidance of the specialist centre – this is known as shared care.

The child’s cancer treatment will usually be planned by a multidisciplinary team of specialists. Led by a consultant oncologist/haematologist, the team may also include a clinical oncologist (specialising in chemotherapy and radiotherapy), a surgeon, a nurse specialist and a pharmacist as well as other healthcare professionals such as dietitian’s, psychologists, physiotherapists and occupational therapists. The team will work together to provide cancer treatment and care for the child.

Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat childhood cancers – they usually compare the standard treatment with a new or modified version of the standard treatment. Information gathered from successive trials has been one of the most important factors in the increasing survival rates for childhood cancer.

Taking part in a clinical trial is entirely voluntary; the medical team will provide detailed information and you will be given plenty of time to decide whether it is right for your child. Children who do not take part will receive the current standard treatment.

Most chemotherapy drugs act by targeting cells which divide rapidly, a characteristic of cancerous cells. There are, however, a variety of other, normal cells which also divide rapidly including the bone marrow, the hair follicles and the lining of the stomach and intestine. This gives rise to the most common side effects of chemotherapy:

• hair loss
• reduction in the number of blood cells produced by the bone marrow – which can lead to anaemia, infection and bleeding
• nausea and vomiting
• loss of appetite and weight

Steroid medicines, often used as part of the treatment regime for childhood cancers, can also cause side effects including:

• increased appetite
• mood changes
• weight gain
• irritability

A small number of children may experience long-term effects, which persist for months or years after treatment, or ‘late’ effects which are problems that do not develop or become apparent until years after treatment ends. Now that so many children are surviving cancer, there is a large population of childhood cancer survivors and these effects are becoming more apparent.

However, as understanding of the biology of childhood cancers advances and our knowledge about treatment-related problems improves, it is increasingly possible to tailor treatments to meet the needs of individual children – optimising the chance of cure whilst minimising the risk of adverse effects. The risk of adverse effects varies from child to child, depending on the treatments used, as well as the age of the child at the time of treatment. Possible effects include:

• heart and/or lung complications. These are associated with both radiotherapy and chemotherapy
• impairment of growth. High-dose radiation to the head, spine or whole body is associated with impaired bone and soft tissue growth
• cognitive impairment. This is a particular concern for children being treated for brain tumours and other children receiving radiation to the head and neck. These children may have impaired intellectual ability and may have problems with visual/perceptual skills and learning ability
• infertility. Chemotherapy and radiotherapy (whole body or in proximity to the ovaries or testes) can both impair facility. Egg or sperm banking may be advised for some children
• thyroid problems. Children who receive high-dose chemotherapy to the neck may develop hypothyroidism (deficiency in the production of thyroid hormone)
• kidney problems. Some chemotherapy drugs carry a risk of long-term kidney damage
• second cancers. Childhood cancer survivors have a small increased risk of developing another cancer later in life. The risk is greatest in those who have undergone radiotherapy but some chemotherapy drugs also increase risk.

This is not an exhaustive list – the risks depend on a number of factors including the treatments and doses used and the age of the child. The risks associated with any treatments will be explained in full by the child’s doctor before treatment commences. Every effort will be made to minimise the risk of adverse effects. All children are followed-up for a number of years after treatment so that any problems can be identified early.