Childhood Cancer

The effects of anticancer drugs vary from person to person and dose to dose. A drug that makes some children violently ill often has no effect on other children. Some drugs produce no nausea until several doses have been given, but others cause nausea after a single dose. Because the effects of chemotherapy are so variable, each child’s treatment for nausea must be tailored to her individual needs.

There is no relationship between the amount of nausea and the effectiveness of the medicine. The development of newer antinausea medications has made a significant impact on the amount of nausea and vomiting associated with chemotherapy. Many children eat normally and never exhibit any signs of nausea while on chemotherapy because of the effectiveness of the antinausea medications.

Following is a list of suggestions for helping children and teenagers cope with nausea and vomiting:

  • Give your child antiemetic (antinausea) medications as prescribed. Nausea is easier to keep under control than to get control of, so never miss a dose.
  • Ask your doctor whether a drug that blocks gastric secretions, such as Pepcid® or Zantac®, would be helpful.
  • Have your child wear loose clothing, because it is both more comfortable and easier to remove if soiled.
  • Try to have at least one change of clothes for your child in the car.
  • Keep large zip-lock plastic bags in the car. They are an easy-to-use and highly effective container if your child gets sick. They can be sealed and disposed of quickly and neatly, ridding the car of unpleasant odors that could make your child’s nausea worse.
  • Carry a bucket, towels, and baby wipes in the car in case of vomiting.
  • Try to keep your child in a quiet, well-ventilated room after chemotherapy.
  • Try not to cook in the house when your child feels nauseated. If possible, open windows to provide plenty of fresh air. Smells can trigger nausea.
  • Use a covered cup with a straw for liquids if your child is nauseated by smells.
  • Do not serve hot foods if the odor aggravates your child’s nausea.
  • Serve dry foods such as toast, pretzels, cereal, or crackers in the morning or whenever your child is feeling nauseated.
  • Serve several small meals rather than three large ones.
  • Have your child keep his head elevated after eating. Lying flat can induce nausea.
  • Provide plenty of clear liquids such as water, juice, Gatorade®, and ginger ale.
  • Avoid serving sweet, fried, or very spicy food. Instead, stick with bland foods such as potatoes, cottage cheese, soup, bananas, applesauce, rice, or toast when your child feels nauseated.
  • Watch for any signs of dehydration, including loose or dry skin, dry mouth, sunken eyes, dizziness, and decreased urination. Call the doctor if your child appears dehydrated.
  • Use distractions such as TV, videos, music, games, or reading aloud to divert attention from nausea.
  • Have your child rinse her mouth with water or a mixture of water and lemon juice after she vomits to help remove the taste.
  • Let your child chew gum or suck on Popsicles® if he develops a metallic taste in his mouth; it may help alleviate the taste of metal.
  • Consider trying acupuncture, aromatherapy, or meditation to help alleviate symptoms.

A friend whose wife had undergone radiation for breast cancer recommended acupuncture to us as being good for energy and mood and lessening nausea. We were certainly worried about his regimen, which for medulloblastoma is 13 sessions of radiation to the full cranium and spine and then 18 sessions to the tumor bed—that’s an awful lot of radiation. So, Ezra went to the acupuncturist every week while he did radiation and the doctors were impressed with his energy level. The fact that he managed to pull off his bar mitzvah on the last day of 6 weeks of radiation speaks well of his stamina.

Another reason we liked the acupuncture was this: because cancer treatment is so grueling, it seems everything we do for the kids harms them in some overt way. They never saw the cancer, and in our case, did not experience any significant harm prior to diagnosis, but since then, Ezra’s life has been a series of painful, damaging, exhausting, and nauseating treatments. Acupuncture was something that was only there to make him feel better, no bad effects. He likes the warm room, the soft table, the soothing music. There is a trickling fountain in the room which he loves. Because it’s hard to fit this treatment into a school week, he didn’t go to the acupuncturist during the 6-week rest period or the first 6-week round of chemotherapy, but at that point he was so miserable, had been vomiting every morning and basically had no good days for 6 weeks, we sent him back to the acupuncturist and he went weekly during the second 6-week round. Maybe it was a coincidence, but his mood has been wonderful and the nausea almost nonexistent over this period. He likes and looks forward to his sessions.

If antinausea medications do not work well for your child, investigate the Food and Drug Administration (FDA)-approved Relief Band®. This wrist band gives an electrical stimulation (too faint to feel) to an acupuncture point on the wrist that affects the portion of the brain that controls nausea. Information about one type of band is available online at http://neurowavemedical.com/products/motionsickness.

Kytril® is an antinausea pill. It is incredibly expensive but brilliant in treating chemo-related sickness. It sometimes takes a bit of juggling to get the timing right; Michael used to take it an hour before taking the CCNU, which he then took at bedtime and slept right through with no ill effects. None of the other antiemetics worked for him nearly as well.

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Liquid promethazine worked fine for controlling nausea, but James’ preschool teacher mentioned how drowsy he was at school, so we asked for something else.

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During Megan’s treatment for anaplastic ependymoma, nausea was a big problem at first. I made a point to work with the staff to address this, and this is the plan we came up with: Megan would be given the maximum tolerated dose of Zofran® the first time chemo was administered, then 4 hours later she’d get the regular dose, then we would give the regular dose every 6 hours.