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Pharmacy works in a child-friendly way

Our pharmacy ensures that the administration form of the (many) medications for children with cancer is always as child-friendly as possible. In cooperation with the treating physicians and nursing specialists, infusions are replaced by injections where possible, injections by tablets and tablets by several small pills or a drink. Everything to make the administration more comfortable for a child or to make the intake easier.

A lot of attention is paid to providing more comfort to children and parents. Lidwien Hanff, head of the pharmacy: 'We are challenged to come up with the smartest solutions for children. During intensive treatment with medication, chemotherapy and immunotherapy, a child's quality of life must remain as high as possible; that is also the mission of the Máxima Center. The advice of the pharmacists and specialized pharmacy assistants on medication is always aimed at maximum comfort for the child, while maintaining the correct effect of the medication.'

When there is choice in administration forms, children and parents can have a say. It happens that a child prefers to swallow several small tablets rather than one large one (co-trimoxazole). Or prefers to choose a drink, although that doesn't always taste good. Also, in some treatment protocols, some injections can be given at home, by home care staff instead of going to the Máxima Center for a day or a few days for an infusion (e.g. cytarabine for ALL). In a few cases, parents can administer them themselves being trained in this, such as immunoglobulins after CAR-T.

A diagnostic MIBG scan often requires a complex medication regimen for a few days to protect the thyroid gland from the radioactivity. Parents receive the correct dose per day from the pharmacy in trays for the morning and evening. The labels contain comprehensible instructions with pictures, which prevents mistakes.

Many children are nauseous during their cancer treatment. Research is being carried out in the Princess Máxima Center to prevent this as much as possible. A longer-term treatment with an anti-nausea agent aprepitant (building up an 'even level') around multi-day chemotherapy is now being looked at. In contrast to a shorter treatment that is given during shorter chemotherapy courses in adults. As a result, the expectation is that a child will feel less nauseous during all treatment days.

Precise dosage
The pharmacy is always closely involved in a stem cell transplant. Lidwien Hanff: 'We are increasingly able to calculate the correct dose of chemotherapy (such as busulfan) by measuring blood levels during the first day of the course and then adjusting the dose for the rest of the course. That helps to dose exactly enough to get the stem cell transplant to work, but not too much so that side effects arise.'

A year ago at the Máxima Center the treatment for children with neuroblastoma changed radically. Instead of an infusion and hospitalization (at intervals) of six times five days, the child now receives a continuous infusion of dinutuximab of six times ten days. The pharmacy prepares a new cassette after three to four days and the child carries the IV in a backpack. ‘The backpack symbolizes the freedom and comfort that a child experiences. That's why we do this. We are working hard to develop more options to make medication child-friendly,’ says the head of the pharmacy of the Princess Máxima Center.