Supportive care
An integral part of oncological treatment is the so-called supportive treatment - the administration of drugs that can prevent the occurrence of medical complications or alleviate the course of existing complications in terms of severity or duration.
To start chemotherapy, it is necessary that the child is in good general condition, that he is not ill with another acute disease (rhinitis, angina, pneumonia, etc.), that the organs involved in the processing of cytostatics (liver, kidneys) are not impaired and that had the basic laboratory parameters of blood count and blood biochemistry as standard.
The child's general condition and the results of some laboratory tests must be evaluated before each subsequent series of chemotherapy. This reduces the risk of acute complications. If the observed values deviate from the norm, it is not possible to continue chemotherapy and it is necessary to wait until they adjust themselves or intervene. A little delay is far better than the onset of severe complications that disrupt treatment far more and that can even endanger the patient's life. Today's internationally used protocols are adapted so that the time between individual chemotherapy series in most patients is just enough to regenerate the body and not give a chance for tumor cells to recover. The treatment should ideally take place on precisely defined dates so that the delays between the individual cycles are as small as possible. However, we treat a living organism that does not behave according to predetermined dates.
Supportive care allows better management of the intervals between chemotherapy cycles and minimizes the occurrence of health complications that could seriously disrupt the course of cancer treatment.
Supportive treatment at the beginning and during chemotherapy:
- Antiemetics - anti-vomiting drugs (Zofran, Ement, Plegomazine). Combination antiemetic treatment usually results in good tolerance of chemotherapy.
- Hyperhydration - a large amount of fluids. The reason is sufficient hydration, support of good kidney function and thus the rapid elimination of cytostatics from the body
- a substance called Leucovorin, which protects healthy tissues when given the cytostatic agent metothrexate
- drugs that are able to block the side effects of large amounts of waste products from rapidly decaying tumor cells (Milurit, Rasburicase) in some types of tumors
- drug Uromitexan, which protects the bladder mucosa from the irritating effects of some cytostatics
- growth factors facilitating the leaching of white blood cells from the bone marrow (Neupogen, Neulasta) in a precisely determined dose, daily, but only for the necessary time, according to the values of the blood count. The drug is administered by subcutaneous (subcutaneous) injection - by a district doctor, a nurse, instructed parents or the patient himself.
- analgesia - medications before the procedure (Dormikum, Morphine). Bone marrow aspirations, lumbar punctures and other procedures are often uncomfortable for children and appropriately chosen medications calm the patient and prevent the perception of possible pain. More about the most common performances <a href="https://cdn.shopify.com/s/files/1/1932/8043/files/200721_ODSTOUPENI_BEZ_UDANI_DUVODU__EN.pdf?v=1595428404" data-gt-href-en="https://en.notsofunnyany.com/">here</a>.
Supportive care at intervals between chemotherapy:
- anti-infective drugs (Biseptol, Sumetrolim, or Mycomax, Sporanox) - cancer patients are particularly at risk for a number of lung and fungal infections and use drugs preventively throughout the treatment
- antibiotics, antifungals, antivirals - for infections in patients with low white blood cell counts and temperature development (so-called febrile neutropenia).
- blood derivatives - with a low number of red blood cells and platelets, patients must be transfused with erymass or thromboconcentrate.
From this brief summary, it is clear that anyone undergoing cancer treatment receives a large amount of medication, usually into a vein. Repeated "puncture" of the venous system is not only unpleasant and painful for patients, but often technically difficult to do - children's veins are thin and fragile, in obese patients they are hidden under a layer of subcutaneous fat and repeated puncture greatly damages the venous wall. Therefore, for most patients with anticipated long-term administration of chemotherapy, we introduce the so-called central venous catheter (CKD).
Palliative treatment
A separate chapter of pediatric hematology and oncology is the so-called palliative treatment. This is a comprehensive care for patients whose oncological disease has reached an advanced stage and it is not in our power to definitively cure the disease. Palliative treatment can slow or even stop the progression of the disease.