After your child goes home from the hospital, treatment will continue with regular visits to the oncology clinic. Before your child leaves the hospital, you will meet their clinic nurse and be given their first appointment. Visits often take a long time, especially if extra tests are needed. Bring a favourite toy or game for your child, snacks, and perhaps a book for yourself.
How frequent are clinic visits?
The frequency of your child’s clinic visits will vary depending on their particular treatment requirements. Some children have a clinic visit once or twice per week, especially if they are receiving chemotherapy. Others may have a different schedule.
Who should come with your child?
Your child must be accompanied by a parent or legal guardian who can give the doctor information and consent for treatment. Please do not bring other children to the clinic because of limited space and infection control requirements.
What happens in a clinic visit?
The procedure for each clinic visit may vary depending on which hospital your child is receiving treatment from and what type of treatment they need. Generally, you and your child will first need to register at the reception desk in the oncology clinic and present a health card. If your child is to have blood tests, the treatment team may recommend giving a topical anaesthetic cream, such as the EMLA patch, to the needle site an hour ahead of the poke.
Tests come first
If your child is still on active treatment, for example, receiving chemotherapy or radiation, a complete blood count (CBC) test is done by finger prick at the beginning of every clinic visit. After the finger prick test, you and your child will see the clinic nurse, who will bring you to an examination room.
The clinic nurse will check your child’s height and weight and will tell you what other tests your child needs. These may include additional blood tests, X-rays, or other procedures. The clinic nurse will explain the tests to you and answer any questions you or your child may have. If your child needs to have X-rays done, you will need to take them to the imaging department.
Seeing the doctor
Once back in the examination room, you and your child will meet with the doctor and nurse to discuss progress since the last visit. Your child’s main doctor works with a number of other oncologists, in what is called a clinic team. Sometimes your child will not be seen by their regular doctor, but instead will be seen by other members of the clinic team. Their findings will always be discussed with your child’s main doctor.
During the clinic visit, your child's doctor may conduct a clinical exam. If your child is seen in the clinic every week, the doctor may only do a clinic exam every four to six weeks. This time interval may vary depending on your child's treatment and wellbeing. The clinical exam often focuses on the neurological exam. The doctor will assess your child's strengths, walking, balance and fine motor movement.
During a clinical exam, the doctor will also do tests to assess the movements of your child's face and eyes. There may also be a hearing test. Other parts of the body may be examined if there are new symptoms or concerns.
Special procedures
Sometimes a special procedure or treatment is needed, such as a lumbar puncture. In this case, the doctor or nurse will explain the test to you. You can choose to stay in the treatment room with your child until your child is anesthetized or go to the waiting room. Afterwards, your child can lie down to rest.
Chemotherapy
If your child is to receive intravenous chemotherapy, they will need to go to another room. In some hospitals, this is referred to as the “IV” room. A nurse will access the IV or port. There are different types of chemotherapy: “quick push” chemotherapy and “infusion” chemotherapy. Quick push chemotherapy is given over a couple of minutes in one quick dose. Infusion chemotherapy is given over a longer period of time.
Radiation
If your child's plan of care includes radiation therapy, you and your child will meet with the radiation therapy treatment team to discuss the plans that are needed for radiation. If your child is a SickKids patient, your child will be seen by the radiology team at the Princess Margaret Hospital where radiation therapy takes place and approximately once per week by the neuro-oncology team at SickKids.
Before you leave
At the end of your child’s clinic visit, the hospital staff will arrange the next appointment. Remember to take your child’s health card and discharge instructions with you, as well as any prescriptions that you have been given.