The occurrence of cancer in children is approximately 2% in Western industrialized countries. Although the incidence of cancer in children is small, it is still the second leading cause of death in children and the primary cause of death from pediatric illness (Smith and Gloeckler Ries 2002). In The Netherlands approximately 370 children per year (Visser et al. 1992) are diagnosed with cancer. Diagnoses typical in childhood cancer are: leukemias (29%) of which acute lymphocytic leukemia (ALL) is the most common, namely 22% of all diagnoses; brain and other central nervous system (CNS) tumors (22%); and cancer of the lymph glands (Hodgkin and non-Hodg-kin lymphoma's, 13%). Other malignancies are less common, such as soft tissue sarcoma (e.g., rhabdomyosarcoma 7%), tumors of the kidney (Wilms' tumor or nephroblastoma, 6%), neuroblastoma (6%) or bone tumors (e.g., Ewing and osteosarcoma, 4%). Besides treatment with chemotherapy, surgery, and radiotherapy, children with cancer are confronted with invasive medical procedures such as bone marrow aspirations, lumbar punctures, and venepunctures. For example, children with ALL face a 2-year treatment protocol with chemotherapy. The treatment starts with the induction phase to induce remission, a state in which the disease is no longer obviously detectable. Further treatment, however, is required to reach cure, and to prevent the occurrence of CNS disease, prophylactic treatment is needed.
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