Children’s nursing student editor, Gary Williams, reflects on his first experience of caring for someone who died and the available cancer treatments in the UK and abroad.
Last week was a turning point in my training as my first patient died while I was caring for him.
The dignity and strength shown by the family was immense and the nurses I worked with were amazing. But I’ve found that since we said goodbye to the patient I’ve been constantly pre-occupied with the what-ifs - as I’m sure his parents are - what if there had been another treatment? What if it had been caught earlier? What if he had grown up without the illness? What would he have become?
Cancer, a dreaded word that has unfortunately touched everyone in some form or other, has yet again been highlighted in recent months by the Stand Up To Cancer appeal. Over the last 12 months I’ve been lucky enough to spend most of my placement time on a neuro ward and the care I witnessed being given to the patients and their families was completely different to any other.
”I’ve found that since we said goodbye to the patient I’ve been constantly pre-occupied with the what-ifs”
Every procedure is a cause for celebration, every milestone is applauded and every loss is felt deeply by everyone. Worryingly the call on cancer treatment resources is increasing though - a statistic supported by recent data that says in the UK there are approximately 4,000 children diagnosed with cancer each year, that’s 10 every single day.
Nobody knows exactly why cancer is triggered in children, after all they’ve not had the lifespan to be affected by poor lifestyle choices such as smoking, or the cellular mutations that occur over one’s lifetime, but what is known is that the growth hormones prevalent in children aid the rapid expansion of tumour development. In the UK, leukaemia accounts for a third of all cancers in the 0-15 year age bracket, with brain and spinal tumours accounting for a further 25%.
”The rapid growth of the brain in children can cause their cells to be highly susceptible to the radiation used during radiotherapy”
While on my placement, the children were supported by play specialists, nurses, oncologists and outside support such as CLIC Sargent representatives and were given standard treatments such as surgery, chemotherapy and radiotherapy. The rapid growth of the brain in children can cause their cells to be highly susceptible to the radiation used during radiotherapy.
While doctors balance the use of radiation against the possibility of the cancer not being affected or even of it returning, they are always mindful of the possible results of learning disabilities being caused due to the non-specific nature of conventional radiotherapy techniques.
A recent article reported that two thirds of all childhood cancer survivors would experience at least one late effect caused by such damage with 25% of all childhood cancer survivors having late effects affecting their endocrine system. An example of such effects would be the potential damage to the hypothalamus and pituitary glands in children with brain tumours treated by radiotherapy. The damage caused can interrupt the production of essential hormones, such as Somatropin (growth hormone) causing long term effects of growth hormone deficiency and decreased growth and development, in adulthood this can cause lack of strength, thinning of bones and anxiety issues.
”Not all radiotherapy causes such widespread damage”
But not all radiotherapy causes such widespread damage.
Remember Aysha King? His parents decided to take him abroad for proton therapy when presented with the potential outcomes of traditional treatments. Proton therapy is usually used for tumours that have not infiltrated the surrounding tissues, which is the main reason the NHS doctors felt it was not suitable for Aysha - although recent reports now show him to be cancer free having had the treatment.
The advantage of proton therapy rather than traditional X-rays is the ability to target the beam to within millimetres of the tumours, leaving unaffected healthy tissue undamaged and causing less side-effects.
At the moment, the NHS has an arrangement with centres in the USA where we send approximately 150 qualifying patients for treatment each year. In April next year, I will be visiting one of these centres to see first-hand how successful the treatment is. I will also see exactly how they use child life specialists and manage to put children at ease to such an extent that anaesthetic use has dropped by 40%, further decreasing the chances of complications and recovery.
Plans are in motion to open such centres here in the UK too in Manchester and London, but these are a few years off being ready. In the meantime, cancer will have to be treated via conventional means for most patients.
As with all patients we have to be mindful of the lasting effects that these treatments can have, so that we can better support our patients and their families to prepare them for what lies beyond being cured.