Lessons learned from survivors of childhood cancer

March 22, 2016 | by City Of Hope

Saro Armenian, D.O., M.P.H. Saro Armenian, D.O., M.P.H.

Saro Armenian, D.O., M.P.H., thinks it's time to put more focus on the health issues patients face after they survive cancer. That's because as a City of Hope pediatric oncologist and director of the Childhood Cancer Survivorship Program, he encounters many young patients with their entire lives ahead of them.

Given recent successes in treating childhood cancers - by 2020, an estimated 500,000 survivors of childhood cancer are expected to be living in the U.S. - decisions made by doctors and parents could impact these children well into middle age.

In a recent editorial for Cancer, a journal of the American Cancer Society, Armenian joins Smita Bhatia, M.D., M.P.H., to consider the long-term impact of medical treatments in childhood. The studies evaluate physical or psychosocial health problems faced by adult survivors of childhood eye or brain cancers, and offer recommendations for improved treatment strategies.

Here are four key takeaways from the editorial:

1. Survivors of retinoblastoma in childhood remain at risk of developing physical health problems by mid-life.

In a recent study of almost 500 adult retinoblastoma survivors, hearing loss and the development of thyroid nodules were found in adulthood. Armenian and the study's authors speculate that both problems may emerge from radiation treatments individuals received as children.

2. A subset of adult survivors of childhood brain tumors will experience psychological or socioeconomic hardship.

Some children with astroglial tumors near the optic nerve become blind as a consequence of radiation or surgical intervention. A study based at St. Jude Children's Research Hospital and conducted at multiple venues finds that, compared to sighted cancer survivors, blind survivors are at greater risk of remaining unmarried, living with a caregiver and being unemployed as adults.

3. Therapies that minimize long-term complications have emerged over the past 20 years.

Some patients surveyed in both studies underwent cancer treatment in the 1970s and 1980s. Brain and eye tumors are still treated by a combination of surgery, radiation and chemotherapy. However, Armenian notes that children treated today may fare better as adults, given the availability of novel chemotherapies or the fact that state-of-the-art radiation protocols are more likely to spare normal tissue. 

4. Treatment regimens for childhood cancers must consider long-term outcomes.

Cancer care is evolving. Armenian's editorial reminds us that the number of long-term cancer survivors is increasing; thus, treatments must move beyond neutralizing the immediate threat (the tumor). Although it is a tall order, the studies he cites urge clinicians and parents to envision a child's quality of life in 20 to 30 years and, when possible, apply "contemporary" therapies designed to halt disease and minimize future complications. If those prove effective, future studies could reflect greatly improved physical, psychosocial or socioeconomic outcomes.

Former City of Hope oncologist Smita Bhatia, M.D., M.P.H., now director of the Institute for Cancer Outcomes and Survivorship at University of Alabama at Birmingham, was the editorial's co-author.

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Learn more about our Pediatric Cancers program. If you are looking for a second opinion or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

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