By SARA ARTHURS
When a child with cancer has a fever — and thus the potential for a life-threatening infection — having to suddenly drive to Columbus for treatment creates a lot of stress for families.
But until recently, that was the only option.
Nationwide Children’s Hospital in Columbus recently began training staff at other emergency rooms around the state, including Blanchard Valley Hospital in Findlay, on the protocol for treating child cancer patients. About the same time, the Braden Kramer Foundation, which helps area children with cancer, approached Blanchard Valley about how to address this.
“Unfortunately, chemo kills good cells and bad cells,” said Maureen Cantwell, clinical leader for outpatient hematology/oncology clinics at Nationwide Children’s Hospital.
This includes the cells that fight infection. Children going through chemotherapy are at risk for infection, as well as bleeding and anemia. Sepsis can be life-threatening, and children usually have a central line, which puts them at high risk of sepsis.
The child typically has a port in their chest, under the skin. This makes them more susceptible to infection, so medical professionals need to use proper techniques when putting a needle into the port.
Cantwell said some ports are “wiggly” and some protrude outside the skin. Others, said Blanchard Valley director of emergency services Natalie Phoenix, can’t be seen but can be felt. Cantwell said Nationwide’s staff works with ports regularly, but even they find the ports “can be difficult to access.”
The reason children have the port is that chemotherapy can be very caustic, Cantwell said. The treatment can cause a burn if it’s not put into a good vein. Port access makes getting chemo “less traumatic” than having to keep putting in an IV. Patients may come in multiple times a week for many months, and having chemo put in through an IV would be torturous for the children without the port, she said.
But the port also increases the risk of infection.
Going through chemotherapy, “They have no immune system,” Cantwell said.
Parents of young cancer patients are told that if their child has a fever at 2 a.m., they need to be taken to the emergency room immediately. Even if they have a doctor’s appointment scheduled for 8 a.m., they should not wait. “It’s an emergency,” she said.
Rich Kramer, Braden’s father, said the family was living so close to Blanchard Valley Hospital he could see it out his window. But if Braden got a fever while he was immunocompromised, Kramer would, after talking to a Nationwide oncologist, have to “white knuckle it down to Columbus.” They wouldn’t make it there within 60 minutes — the window in which the child is supposed to get the antibiotics.
And Kramer said about 60 percent of the time, Braden would be admitted to the hospital. But the other 40 percent of the time, they’d be in the ER for about four hours, then sent home. This can be stressful for the child, parents and siblings, Kramer said, and if you are going to be sent home rather than admitted, it would be much simpler to visit your local hospital’s ER.
Braden was diagnosed with a form of leukemia in September 2015, shortly before turning 5, and ended treatment in January of this year.
Kramer said there are nine other “superheroes” locally getting assistance from the Braden Kramer Foundation as they navigate the world of pediatric cancer care. “I’m so excited for families” that they’ll now be able to get care locally, he said.
Nationwide also developed a card that parents can present at the ER. The card says the child is immunocompromised and gives information about their situation — and the importance of giving antibiotics within one hour, without waiting for lab results. Cantwell said having everything on the card means the parent can just hand the card to the health care provider, rather than having to remember all the specifics.
Phoenix said emergency room staff would take an all-hands-on-deck approach for these children, but the effort with Nationwide give them more certainty that they’re doing exactly what the child’s care team has agreed upon.
She said broad-spectrum antibiotics are given immediately, and once they have done tests to determine the specific bacteria, ER staff can then choose an antibiotic that zeroes in on it.
In some cases, they do end up transferring the child to Nationwide. But sometimes they’ll be discharged, and then follow up with their doctor as an outpatient.