Changes to This Summary (03/06/2013)
About This PDQ Summary
Questions or Comments About This Summary
Get More Information From NCI
Key Points for This Section
- The goal of supportive care is to improve the quality of life for young cancer patients and their families.
- Cancer in children is different from cancer in adults.
- Children of different ages need different treatment and support.
- A child's circle of family and friends may be larger than it usually is for adults.
- Most decisions about care will be made by the child's parents or guardians.
Note: Information about physical adjustment to treatment, problems with physical and cognitive development, and life after cancer treatment will be added to this summary in the future.
Most children with cancer can be cured. However, cancer treatment for young patients can cause unwanted side effects and other problems during and after treatment. Early treatment of cancer symptoms and the side effects of therapy helps patients feel better, stay stronger, and cope with life after cancer. Supportive care improves the patient's physical, psychological, social, and spiritual quality of life.
Supportive care is given to children of all ages, including infants, children, adolescents, and young adults.
Cancer in children and young adults is different from cancer that develops later in life. Childhood cancers usually do not act like adult cancers and are not treated the same way:
In general, treatments for childhood cancer use higher doses of chemotherapy and radiation than is used for adults. These treatments may also be given over a shorter amount of time than in adults. This is because children can receive more intense treatment (higher doses given over a shorter time) than adults can, before serious side effects occur.
- Side effects
Some of the unwanted side effects of cancer treatments cause more harm to children than they do to adults. This is because children's bodies are still growing and developing, so cancer and its treatment are more likely to affect developing organs.
Side effects of chemotherapy and radiation therapy may happen right away or weeks or years after treatment. Cancer treatment may also affect a child's growth or cause a second cancer to form. Problems that appear weeks or years after treatment are called late effects. Because of possible late effects, childhood cancer survivors need life-long follow-up. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
- Supportive care
The types of supportive care given to children may be different from those used for adults. For example, certain medicines used to control symptoms in adults may not be safe for children.
The treatments and supportive care will be different for different age groups and will change as the child grows and develops. For some cancers, the prognosis (chance of recovery) and risk of late effects depend partly on the age of the child at the time of diagnosis or treatment. See CureSearch for more information about treatment and support for different age groups.
Even with a diagnosis of cancer, the child will still be going to school, spending time with friends and family, and enjoying many activities that were a part of life before cancer. The child's circle of family and friends may be large. In addition to parents, brothers, and sisters, many others may be closely involved in the child's everyday life. This includes grandparents, aunts, uncles, cousins, teachers, schoolmates, and friends. Everyone in a child's circle of family and friends are affected by the child's cancer diagnosis and treatment, and possible side effects of treatment.
Children under the age of 18 don't have the legal right to make their own decisions about treatment. Their parents or guardians legally make these decisions for them. Decisions about treatment may be difficult because of this. There are ethical concerns about informed consent (the process of giving information about possible treatments and their risks and benefits, before treatment decisions are made). In the treatment of children, parents are informed and decide whether to give permission for the treatment. Whenever possible, it is best that the child be involved and agrees with decisions about treatment.
Key Points for This Section
- Most children who have cancer adjust well.
- The type of cancer and the treatments used can affect adjustment.
- Depression and Suicide
- A small number of children may have problems that lead to depression or suicide.
- Certain antidepressant medicines may cause suicidal thoughts or actions in children, teenagers, and young adults.
- It is important that survivors of childhood cancer have regular mental health check-ups as part of follow-up care.
- Post-traumatic Stress Disorder and Symptoms
Cancer treatment is stressful on the child and the family. However, studies have shown that most children treated for cancer, and children who are long-term survivors of cancer, have few serious psychological problems.
The early days of treatment, when the child is often in the hospital, are usually the most stressful for the child and the family. The child may be anxious about being away from home and receiving new treatment. This anxiety usually decreases over time. Studies have reported that, in general, children treated for cancer have no differences from other children in self-esteem, hopefulness, depression, anxiety, or loneliness.
Children who have a lot of support from their family are less likely to have problems adjusting.
Some of the factors that may increase the risk of social, emotional, or behavioral problems include:
- Having leukemia, lymphoma, or a cancer or treatment that affects the central nervous system (brain and spinal cord).
- Having a stem cell transplant.
- Having family problems.
- Being younger than school age during treatment.
Some studies have shown that physical and emotional distress related to cancer and its treatment can cause mental health problems in certain childhood cancer survivors. These problems include depression that needs treatment and can lead to suicide. Signs of depression include the following:
- Feeling empty, worthless, unloved, or that life isn't worth living.
- Feeling nervous, restless, or irritable.
- Changes in appetite.
- Low energy.
- Sleep problems.
- Decreased interest in activities.
- Increased crying.
Drugs called SSRIs (selective serotonin reuptake inhibitors) have been shown to decrease depression in young people. SSRIs usually have few side effects but they may cause suicidal thoughts or actions in young people (children, teenagers, and young adults). The Food and Drug Administration (FDA) has warned that young people up to age 25 who are taking SSRIs should be watched closely for signs that the depression is getting worse, especially suicidal thinking or behavior. Close monitoring is especially important during the first four to eight weeks of treatment. The patient, family, and health care provider should discuss the risks and benefits of using SSRIs to treat depression.
The side effects of SSRIs have not been studied in children, adolescents, or young adults with cancer.
Follow-up cancer care may be given by the cancer treatment doctor or the main provider, such as the family doctor. It is important that regular mental health check-ups be part of this follow-up care. A patient who shows signs of depression or other mental health problems during follow-up care may be referred to a therapist or other mental health specialist. Many survivors get help from therapists who are experts in helping people who are recovering from cancer.
Being diagnosed with a life-threatening disease and receiving treatment for it is often traumatic. This trauma may cause a group of symptoms called post-traumatic stress disorder (PTSD). PTSD is defined as having certain symptoms following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others.
People who have survived very stressful situations, such as military combat or natural disasters, may also have PTSD. PTSD can affect cancer survivors in the following ways:
- Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
- Avoiding places, events, and people that remind them of the cancer experience.
- Being constantly overexcited, fearful, irritable, or unable to sleep, or having trouble concentrating.
Because avoiding places and persons connected to the cancer is part of PTSD, survivors with PTSD may not get the medical treatment they need.
Childhood cancer survivors who are diagnosed with PTSD are more likely to have depression and to have difficulty with common aspects of young adulthood, such as doing well in school, taking part in social activities, and reaching career goals.
In children and teens with cancer, symptoms of PTSD may occur during treatment or after treatment has ended. Those who feel very uncertain about their disease and future may be more likely to have PTSD symptoms. Parents and siblings (brothers and sisters) of childhood cancer survivors are also at high risk for PTSD.
It is important that cancer survivors and their families receive information about the possible psychological effects of their cancer experience and about early treatment of symptoms of PTSD.
Follow-up cancer care may be given by the cancer treatment doctor or the main provider, such as the family doctor. It is important that regular mental health check-ups be part of this follow-up care. A patient who shows signs of PTSD or other mental health problems during follow-up care may be referred to a therapist or other mental health specialist. Many survivors get help from therapists who are experts in helping people who are recovering from cancer.
Key Points for This Section
Parents feel great distress when their child is diagnosed with a life-threatening disease. Over time, the level of distress may lessen. Each family is affected in its own way, and different members of the family will react in different ways.
Certain factors may increase the family's level of distress:
- The cancer patient is at a young age when diagnosed.
- The cancer treatments last for a long period of time.
- The child with cancer dies.
The entire family must adjust to changes in normal routine as the parents cope with the child's treatment, look for information, and try to also take care of the brothers and sisters. The parents' attention is focused on the child with cancer.
Brothers and sisters of the cancer patient need help to cope with their feelings of anxiety, loneliness, and fear. Brothers and sisters who are bone marrow (stem cell) donors for the cancer patient may have anxiety. Siblings who are not bone marrow donors may have school-related problems.
Although stress -related symptoms are common in siblings of childhood cancer patients, they sometimes report that their experience has made them more compassionate and that the cancer experience has brought their family closer together.
Parents who are working and who have support from family, friends, and the health care team usually have lower levels of distress and feel more positive about their child's experience. Social support programs, such as support groups and summer camps, help brothers and sisters cope with the illness more easily.
Key Points for This Section
Even though new and better treatments have increased the chances of a cure or remission, some types of childhood cancer do not get better. When a child's cancer does not get better or comes back, parents may not be sure about whether to continue treatment and, if so, what kind.
Parents who are caring for a child at the end of life need a lot of support that includes family members and the child's health care team. The health care team can help parents understand how different types of treatment can affect their child's quality of life. Parents have to decide if they want their child to continue to receive treatment even if it is not likely to affect the cancer. They also have to decide if they want their child to take part in decisions about end-of-life care.
Parents have reported that they find the most support from cancer treatment doctors who:
- Give clear information.
- Communicate in a caring and sensitive way.
- Communicate directly with their child as needed.
- Let them know what to expect as their child nears death and help them get ready for it.
Some medical centers that specialize in cancer care for children have services that help with palliative and end-of-life care. These support services may include:
- Pediatric palliative care team.
- Pain service.
- Hospice care.
- Psychological and social support team.
- Bereavement program.
- Complementary and alternative medicine (CAM) services.
Other services that are helpful but may be harder to find include:
- Programs for siblings of children who are receiving end-of-life care.
- Hospice programs that accept children who are still receiving chemotherapy.
- Clinical trials that combine complementary and alternative treatment with standard treatment.
Even when palliative care and end-of-life care support services are not available, cancer treatment doctors may suggest other options to parents. If parents have home health care support, many are able to plan and give their child end-of-life care at home. This can have the following positive effects:
- The child may not need to be admitted to the hospital as often.
- The parents feel that they have more control and are better able to accept their child's death.
- If the child does die in the hospital, he or she is less likely to die in an intensive care unit, which often uses invasive treatments.
When a child nears the end of life, the whole family needs compassionate medical, spiritual, emotional, and practical support. This includes the following types of help:
- Communication that is caring and sensitive to the needs of the child and the family. Communication should be based on the child's age and stage of development.
- Palliative care that includes ways to manage pain and other symptoms at the end of life. Medicines and non-drug treatments can relieve pain, agitation, itching, nausea, vomiting, and seizures. Platelet transfusions may be given to help prevent bleeding.
- Support for the emotional and spiritual needs of the child and the family that are based on differences among family members and on the family's cultural beliefs.
- Bereavement care which may include helping families create memories with the child, such as photo albums or handprints. It also helps the family to know what to expect at the time of death and in the days, weeks, and months that follow. Bereavement support sessions may be offered after the child's death. See the PDQ summary on Grief, Bereavement, and Coping With Loss for more information.
- Advance care planning to help the family make decisions about:
- Types of treatment to be used.
- Whether the family wants the child to die at home.
- Whether the family wants hospice care.
- Funeral arrangements.
- Whether a Do Not Resuscitate (DNR) order will be in place.
- Whether taking part in decisions would help the child.
- Information and advice from the health care team about medical, ethical, and legal issues.
Good end-of-life care includes treatment and support that is based on the special needs of the child and family and improves their quality of life.
See the PDQ summary on Last Days of Life for more information.
Changes to This Summary (03/06/2013)
Editorial changes were made to this summary.
About This PDQ Summary
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.Purpose of This Summary
This PDQ cancer information summary has current information about supportive care issues related to treatment in children and adolescents. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials are listed in PDQ and can be found online at NCI's Web site. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).Permission to Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
The best way to cite this PDQ summary is:
National Cancer Institute: PDQ® Pediatric Supportive Care. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/supportivecare/pediatric/Patient. Accessed <MM/DD/YYYY>.
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.Disclaimer
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.Contact Us
More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site’s Contact Form.
Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Get More Information From NCI
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- 9609 Medical Center Dr.
- Room 2E532 MSC 9760
- Bethesda, MD 20892-9760
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).