The Child with Cancer

Cancer is a group of conditions characterized by uncontrolled cell growth that goes unchecked by the immune system. Cancer can be broadly classified as hematologic or blood-borne cancers, and solid tumors.

Hematologic cancers, such as acute lymphoblastic leukemia, acute myeloid leukemia, and Hodgkin lymphoma, arise from immature blood cells or lymphatic cells. In these cancers, the continued uncontrolled multiplication of immature cells interferes with the development and function of healthy blood and lymphatic cells. On the other hand, solid tumors develop from specific organs. These tumors can arise in the bones, like osteosarcoma; the kidneys, like nephroblastoma; or in the colon, like colon cancer.

Regardless of the type, cancer is typically caused by genetic mutations altering cell division. Diagnosis involves a history; physical assessment; laboratory tests such as a CBC; diagnostic imaging, like MRI; and diagnostic procedures, like lumbar puncture or bone marrow biopsy. Treatment depends on the type and staging and can include surgery, chemotherapy, biotherapy, radiation therapy, and hematopoietic stem cell transplant. While treatment aims to destroy cancerous cells, it also destroys non-cancerous cells leading to undesired side effects in your patient.

Now, when caring for a child with cancer, you’ll manage the side effects of cancer treatment. Chemotherapeutic agents and radiation therapy to the head or abdomen can cause GI side effects, like nausea and vomiting, which may cause your patient to eat or drink less. Given these side effects, you’ll monitor their nutritional status, weight, intake and output, and signs of dehydration.

Also, remember to administer the prescribed antiemetic medications, and implement nonpharmacologic interventions for your patient, like distracting them through playing with toys or encouraging them to talk with their friends.

To support their nutritional status, encourage your patient to drink fluids like Pedialyte to replace fluids and electrolytes, and to eat small, frequent meals throughout the day. Also be sure to teach your patient and their caregivers ways to increase their caloric intake, such as using full-fat dairy products, adding tofu to meals to increase protein, and eating snacks like trail mix, peanut butter, and dried fruit. If oral intake isn’t possible, administer enteral or parenteral nutrition as prescribed. You may also need to consult the registered dietitian and child life specialist as needed.

Next, assess for oral ulcers. These may appear as red or eroded lesions in your patient’s mouth, and they can make it difficult to chew and swallow food. If oral ulcers develop, administer the prescribed solutions such as sucralfate to coat the ulcers before eating. Also, perform oral hygiene at least every four hours as well as before and after eating, using mouth rinses with baking soda and salt, or solutions like chlorhexidine.

Since oral ulcers are tender and painful, try using a soft sponge toothbrush instead of a regular toothbrush for oral care. If your patient resists a toothbrush, which is common with infants and toddlers, try wrapping gauze moistened with water or saline around your finger to gently cleanse their mouth. You can also suggest bland, moist and soft foods, like yogurt or pudding, that are less irritating.