Childhood cancer survivors need to prepare for future risks

Few cancer diagnoses are more devastating than those of childhood cancers. Noticing an unusual lump or swelling in a child, taking a son or daughter in because of increased lethargy or pain and having a doctor share a diagnosis for leukemia, lymphoma, neuroblastoma, kidney tumors, bone, or other cancer is crippling for the entire family. Families are forced to band together, to dig deep and work as a team to support the child through their fight — and fight they do. The strength of children who go through this battle and come out the other side as a cancer-free hero ringing that bell at the end of their journey is inspiring.

But, unfortunately for some, their battle is not over. Both long-term adverse effects of chemotherapy and radiation, as well as the possibility of recurrence of the underlying cancer are causes for continuing concern.

Late Effects of Treatment

Just as the treatment of childhood cancer requires a very specialized approach, so does aftercare and watching for late effects – side effects of cancer treatments that can show up months or even years later. Late effects can involve more than one part of the body (or more than one organ system) and can range from mild to severe. For example:

• Some types of chemotherapy, given either into a vein (intravenous or IV chemo) or directly into the spinal column (called intrathecal chemo or “spinal tap chemo”), can cause learning disabilities in children. This is more likely if higher doses of certain chemo drugs are used and if the child is young at the time of treatment. Learning disabilities are more common in children who get both chemo and radiation to the brain.
• Radiation therapy to the eye can sometimes damage inner parts of the eye, which can lead to vision problems. Radiation in the area of the eye can also cause cataracts (clouding of the lens of the eye) over time. Radiation treatment to the bones near the eye may also slow bone growth, which can change the shape of the child’s face as it grows. Other late term eye injuries include eyelid tumors and dry eyes.
• Certain chemo drugs and antibiotics may cause hearing loss (especially high-pitched sounds). Radiation given to the brain or ear can also lead to hearing loss, as can surgery in these areas. This risk may be higher in children who are under the age of 5 at the time of treatment.
• Other organs, such as the lungs and the musculoskeletal system, can also suffer adverse effects from chemotherapy and radiation.
• Chemotherapy and radiation before five years of age can also cause problem with tooth development and gum disease.
• Slowed growth is a common problem during childhood cancer treatment. Over time, many children catch up to a normal growth pattern after treatment. But certain chemo drugs, when given in high enough doses, have more lasting effects. Many of the late effects on growth and development are linked to radiation therapy which can directly affect growth of bones in the area being treated. Radiation and surgery can sometimes damage the pituitary gland, which is the main gland of the endocrine system. This can sometimes affect overall growth and development.

Treating childhood cancer and saving young lives are two of the most important gifts modern medicine has given us. Being mindful of the long-term side effects of chemotherapy and radiation therapy helps tailor treatments to minimize the price of cure. Cancer treatment that may be appropriate for adults, may not be for children. Delayed diagnosis of childhood cancers may necessitate more aggressive treatment for cure, but at an increased cost in the future.