Childhood Cancer

All infants, most preschoolers, and some school-aged children require sedation or a short-acting anesthesia (most commonly propofol given intravenously) to ensure they remain perfectly still during radiation therapy. Parents will receive written instructions about when their child should stop eating and drinking before sedation or anesthesia.

About 1 month after he was diagnosed, Sam started a course of 30 daily radiation treatments. In some ways, this was the easiest part. Each day we woke up at the same time we always had, got dressed and went directly to the hospital. Because of Sam’s young age, he received anesthesia so that he would lie still for the radiation session. He had a Hickman® catheter in his chest, so that made getting the anesthesia into him a quick process. The anesthesia acted very quickly, and the technicians and nurse would place him in position and the treatment would start. Each session lasted about 15 minutes. He’d then be moved into a recovery area where I’d wait while he awoke. He usually came out of it happy, but hungry. I learned to pack lots of easy snacks, like cheerios, crackers, and juice boxes. Once he was fully awake, I’d wheel him to the car in the baby stroller. Most days we were home by 9:30 am. One of the blessings of daily radiation is seeing nurses and technicians every day. I was very touched by the caring and comfort of the staff in the radiation department. Another benefit of the daily radiation was being able to change the dressing on Sam’s Hickman® while he was under anesthesia.

Anesthesia is given through a small plastic mask or through the child’s catheter or intravenous line (IV). Sometimes the parent can hold or comfort the child while anesthesia is administered, but the parent must leave the room before radiation treatment begins. Once your child is awake and can swallow, you can take her home. The entire procedure generally takes 30 to 90 minutes.

Kenny had 24 cycles of radiation under anesthesia to treat his rhabdomyosarcoma. At first it was really horrible for me to leave him in that big, dark room. I would hold his anesthesia mask over his face until he was asleep, and then I would leave. I was the last and first face he saw every time. Kenny was so brave. Towards the end of the 24 treatments, he would stand in front of the big doors yelling, “Hurry up in there! It’s my turn to go night-night!” The only request he had was that a Coke and a green Popsicle® be waiting for him when he woke up.

Nausea and vomiting are occasional side effects of anesthesia, but they can usually be controlled by antinausea drugs such as ondansetron (Zofran®). Over time, your child may become comfortable with the treatment and not require anesthesia.

Each time my young son came in for radiation, part of the routine was to place the hard plastic mesh mask over his face while he was awake, just for an instant, to get him used to the idea of trying to wear it for treatments without sedation. No pressure was ever put on him about it, it was just mentioned as a possibility of something he could try, something that would let him keep eating and drinking all through the day, instead of having to fast for a few hours before each sedation, which was very hard for such a small boy who was getting sedation twice a day.

They left the mask on him for a tiny bit longer each time, until he was tolerating it for several seconds, and by the end of the third week, close to a minute. His fifth birthday was at the exact middle of treatment, and he decided that since he was such a big boy now, he would try to do it without sedation. I know he was trying to please and impress all these kind people. He worked it out quietly with a favorite technician, asked the “sleepy medicine doctor” to wait outside the treatment room, let them screw the mask down to the table and did the whole thing awake.

I’ve never been more proud in my life. Everyone cheered and hugged him. He finished the last three weeks of treatments without sedation, sometimes eating and drinking on his way in the door just to show off that he could!