What are the side effects of induction chemotherapy? 

Induction chemotherapy uses strong medicines to destroy fast-growing cancer cells and shrink neuroblastoma at the start of treatment. Chemotherapy also affects healthy cells as the chemotherapy cannot tell which is a cancer cell and which is not. This means that chemotherapy can cause side effects. Not all children experience the same side effects. Many are temporary and improve once treatment finishes. Your child’s healthcare team will monitor them closely and support you in managing any difficulties. 

Short-term side effects 

Short-term side effects usually happen during induction chemotherapy or shortly afterwards. These may include: 

• tiredness and feeling unwell: Children often feel very tired and generally unwell during and after treatment. Rest and gentle activities can help. 

• sore mouth and throat (mucositis): Painful sores can develop in the mouth, making eating, swallowing, and talking difficult. Mouthwashes, pain relief, and nutritional support can help manage these symptoms. 

• hair loss: This is usually temporary. 

• nausea and vomiting or diarrhoea: These are common but can usually be managed with medicines. 

• loss of appetite: Some children may need additional nutritional support, such as a nasogastric (NG) tube, if they are unable to eat enough. 

• impact on blood counts: As the chemotherapy affects all cells (cancerous and healthy) this impacts the blood counts and can make children more likely to get infections.  Blood counts will be monitored throughout treatment and blood products (red blood cells or platelets) can be given to support these.  There is also a medication to stimulate the growth of white blood cells which help fight infection. 

• increased risk of infection: After chemotherapy, it can take several weeks for blood counts to recover. During this time, children are more likely to get infections. The team will monitor for signs and may give antibiotics or anti-fungal medicines to help prevent or treat infections. 

Medicines, mouth care, dietary support and infection prevention measures can help manage many of these effects. 

Possible longer-term side effects 

Some chemotherapy drugs used during induction can cause longer-term side effects, particularly because children’s bodies are still developing. The likelihood of these depends on factors such as your child’s age, the specific drugs used and the total doses given. 

Possible longer-term effects can include: 

• Hearing problems 

• Effects on growth or development 

• Effects on organs such as the heart or kidneys 

• Fertility problems later in life 

Your child’s treatment team should talk to you about any potential longer-term risks and explain how these are monitored during follow-up care. 

Monitoring and support 

Children receiving induction chemotherapy are monitored closely throughout treatment and afterwards. If you have concerns about side effects at any stage, you should speak to your child’s healthcare team, who can offer advice and adjust supportive care where needed.