Childhood Cancer Survivorship: The beginning of the rest of their lives

Children With Cancer

Let me tell you about a few young people:

  • A 3-year-old girl is diagnosed with the most common type of leukemia in children (acute lymphoblastic leukemia or ALL). She is treated with chemotherapy for about 2.5 years.

  • An 11-year-old boy is diagnosed with a bone cancer called osteosarcoma. He is treated with surgery and 9 months of chemotherapy.

  • A 17-year-old girl is diagnosed with Hodgkin lymphoma and treated with 3 months of chemotherapy and radiation to the chest.

"Late Effects" of Cancer Treatment

These hypothetical children and adolescents are representative of the many young people who are diagnosed with cancer each year. Because of improvements in treatment, more than 80% of children with cancer will survive long term. However, their last day of cancer treatment is not the end of the cancer experience, as many of the therapies that were necessary to treat the cancer increase the risk of developing other health problems in the future, called “late effects”.

Cancer treatments for children are similar to those for adults (surgery, chemotherapy, radiation therapy, newer targeted biologic therapies and immune therapies); however, the effects of these treatments on each individual vary depending upon the age of the child at the time of treatment, and what is happening in terms of their growth and development.

Some of the factors that impact the likelihood of developing late effects of treatment include age at time of treatment, dose and duration of exposure, and the amount of time that has passed since this treatment. Because the youngest children have the longest life yet to live, it is all the more important to understand the risk of late effects over their lifetime, and to develop guidelines for screening for late effects, such as the Children’s Oncology Group Long-Term Follow-Up Guidelines.

What Does Childhood Cancer Survivorship Care Look Like in Practice?

Fast-forwarding 20 years in the future for each of the patients described above, here is a sample of what this may entail:

  • The 23-year-old survivor of ALL has her cholesterol and weight checked regularly, because the chemo she received increases her risk of having high cholesterol and being overweight.

  • The 31-year-old survivor of osteosarcoma has an echocardiogram (ultrasound of the heart) every year, because the chemo he received puts him at risk of heart dysfunction.

  • The 37-year-old survivor of Hodgkin lymphoma has a mammogram and breast MRI every year (since age 25), because the radiation she received increases her risk of breast cancer.

With the development of promising new cancer therapies, such as those that are targeted at a specific biologic change in the cancer, or those that train the immune system to fight cancer, there is a growing need to understand the late effects of these new therapies. As oncologists, it is our responsibility to continue to study and monitor for these late effects, so that we can help all of our patients live the best life possible, for the rest of their lives.