Care and mobility considerations
Care
All children undergoing treatment for Wilms tumour will at least undergo radical surgery and chemotherapy and develop care needs during their chemotherapy treatment. Duration of treatment will be ‘key’ to needs assessment.
Older children undergoing treatment may have more care needs than younger children. Children aged 5 and above are likely to be substantially self caring – any help with feeding, toileting and mobility in this age group is likely to be related to their condition rather than immaturity. Children may be immunosuppressed and unable to attend school on a regular basis, requiring care and protection from infection at home. Preschool children who normally attend nursery may need to be cared for in a safe environment rather than nursery to reduce risk of infection. Some children may still attend but reduce their hours.
Children of all ages are likely to require extra emotional support and practical help from their parents related to both treatment and the disease. In relation to treatment, parents will need to spend time doing the following for any child undergoing chemotherapy treatment:
- Supporting their child through painful or distressing treatment,
- Ensuring any oral drug treatments are taken as prescribed, despite side effects,
- Care of central line, if used (see Equipment used (access) for giving chemotherapy),
- Monitoring their child for the side effects of treatment – this includes monitoring for signs of:
- infection,
- easy bruising,
- bleeding, and
- anaemia.
- Protecting their child from infection during periods of immunosuppression and monitoring for signs of infection,
- Encouraging their child to eat during periods of stomatitis or mucositis (sore dry mouth) and providing mouth care,
- Providing an appropriate diet for the child when immunosuppressed, some children will require enteral feeding (tube feeding), some children develop food fads and food aversion, some children require dietary supplements,
- Emotionally supporting their child through their illness e.g. dealing with hair loss/time away from school/ being different to peers
- Episodes of severe fatigue may endure for many months related to chemotherapy treatment and anaemia. Younger children will require help with all aspects of self care and dressing because of their age. Older children may also require such help due to severe fatigue.
Some children will require additional care for:
- Peripheral neuropathy related to chemotherapy – numbness or tingling may make using the hands difficult due to numbness. This is rare. May affect personal care, toileting ability, feeding and dressing. May affect walking.
- A small number of children will develop end stage renal failure and may need kidney dialysis in addition to their anti-cancer treatment. Kidney transplant is common after Wilms tumour treatment and is usually delayed for 1 to 2 years after successful treatment.
- Terminal illness.
Mobility
Severe fatigue related to chemotherapy treatment and anaemia may affect walking for periods during treatment but this is not a continual effect over 6 months or more.
A small number of children may experience side effects of chemotherapy that can affect walking and these include numbness in the feet affecting balance (risk of falls) and hand foot syndrome. Full recovery is expected in these cases. The best source of evidence on mobility problems and ability to recover is the treating oncologist or specialist nurse.
