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		Side Effects of Treatment
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		Finishing the Treatment
		Relapse

Side Effects of Treatment

In the treatment of the various cancers of childhood, side effects are often encountered and these need to be discussed and understood. The three major forms of treatment: chemotherapy, radiotherapy and surgical operations all have their specific potential unwanted effects. There are separate sections dealing with Radiotherapy and Surgical Operations.

Chemotherapy is the use of drugs designed to kill cancer cells throughout the body. These drugs can also damage some normal cells, particularly those that are actively dividing and growing. For example the bone marrow, where the various cells in the blood are being produced, is susceptible to suppression by chemotherapeutic drugs. Further examples of such generalized effects include other components of the immune system, the hair follicles (hair loss), the lining of the mouth (mouth ulcers) and the gut (nausea). Loss of hair is temporary and hair WILL grow back, but it may still be perceived as a problem, particularly in teenage girls. For this reason wigs are available and many patients wear hats of various kinds.

The most relevant of these short-term potential side effects is the effect on immunity and, therefore, the reduced capacity to fight off certain infections. With regard to infections, it is important to remember that should a fever occur (over 38^oC) it is necessary to check the number of white cells, and in particular neutrophils (the white cells responsible for fighting bacteria) in the blood, as soon as possible. The decision on how to treat a fever will depend very much on the blood count at the time. It is necessary to use antibiotics by vein if the blood count is low (neutrophils less than 500) and the fever persists. Unlike normal children, patients on chemotherapy may get very sick quickly if correct treatment is not given. We do not use Panadol (and aspirin is NEVER used in patients on chemotherapy) because it will mask the fever and the underlying infection. Once the infection is identified and antibiotics are started we use Panadol when necessary (but again NEVER aspirin because it can cause bleeding).

The other important precaution with regard to infections, is to be aware of possible contact with either chickenpox or measles. It is essential to inform school, kindergarten, friends and other potential contacts about this risk. Therefore, should any child (or adult) who has been in contact with the patient develop measles, chickenpox, or even shingles (a localized form of chickenpox) the family concerned should immediately be notified so they can then discuss this problem with their doctor. Remember, these infections are contagious from two or three days prior to the appearance of spots or fever. We then have the option of offering an injection to try and prevent catching the infection, if the contact appears to be a significant one. This whole philosophy hinges on good communications between the family and potential contacts the child may encounter.

In addition to the generalized side effects of chemotherapy there are certain special effects that individual drugs may have. To make detailed information readily available, we have designed individual fact-sheets for each drug and you will be given such a sheet for each of the drugs included in the treatment. While the potential side effects are many, most of them will not be encountered. Furthermore, a lot of effort is made to recognise potential side effects before they cause any significant damage. This is done by regular tests such as checking the blood count, the function of the kidneys, the liver, the heart, hearing and so on. Should there be any evidence that early damage is occurring we will modify the drug regimen as necessary. Treatment protocols need to be varied and drug doses adjusted for individual patients in response to results from all the tests and checks. Everybody is a little different and we need to individualize. Sometimes, if a side-effect (especially drop in white cells in the blood) is persistent, the treatment may need to be delayed for several days.

The monitoring for potential side effects goes on during and also far beyond the treatment duration. In the section called "Finishing the Treatment", the long-term potential complications, as well as our system for continuing checks for these, are explained. It is important that you ask questions and discuss any possible side effects or long term damage that are of particular concern to you.

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