By Dr. Jonathan Fish, M.D., St. Baldrick’s Scholar, Steven and Alexandra Cohen Children’s Medical Center of New York.
- Almost 80% of children diagnosed with cancer will be cured of their cancer, joining the growing population of long-term childhood cancer survivors
Thanks to advances in chemotherapy, radiation and surgical techniques, more children are being cured of cancer every year. While this is truly excellent news, even modern treatments can have long-term consequences.
- Over 60% of long-term childhood cancer survivors have a chronic illness as a consequence of the therapy they received, and over 25% have a severe or life-threatening illness
The health risks survivors face as they age depend on the exposures they received as treatment for their cancer. Each chemotherapeutic agent, radiation dose or surgery has unique potential long-term consequences. The health risks include second cancers, heart disease, infertility and many others. Understanding the exposures and developing a personalized, risk-based screening plan is critical to maintaining wellness for survivors.
- In addition to the risks to physical health many survivors experience anxiety: 16% of survivors meet criteria for post-traumatic stress disorder
Anxiety and depression can have a profound impact on wellness, even in those with excellent physical health. Knowing the signs of anxiety or depression, recognizing that these do not represent a failure or weakness, and accepting help can greatly improve survivor wellness.
- There are over 325,000 survivors of childhood cancer in the United States, representing approximately 1 in 570 young adults
While childhood cancer is relatively rare (14,000 cases in the United States per year), survivors of childhood cancer are common. Especially given the unique health risks survivors face, teaching primary care providers and medical specialists about this important, large and growing group of patients is very important. Forming care-partnerships between survivorship specialists and primary care providers can be an effective way of optimizing survivors’ health.
- Approximately 75% of centers that treat childhood cancer have some form of long-term follow-up program
Providing individualized, risk-based screening plans and coordination of care for childhood cancer survivors is becoming more and more important. In fact, the care of survivors of childhood cancer has developed into its own medical subspecialty, with a few centers across the country even offering specialized fellowship training in survivorship. Some centers follow patients for life, others have transition programs where childhood cancer survivors who are now adults can be followed in adult-centered programs that focus on childhood cancer survivor health risks. For survivors, finding a center that can provide individualized, risk-based survivorship care has become easier, but it is up to the survivors to take that first step and contact the center to establish care!
Dr. Fish’s Survivorship Research, funded in part by the St. Baldrick’s Foundation:
“Without support from the St. Baldrick’s Foundation, it would not have been possible to establish the survivorship program, let alone the advances it has already provided in terms of survivorship research,” said Dr. Fish. “Funding of this St. Baldrick’s Scholar Award was, and is, essential to this important clinical and research program.”
Many centers are conducting research to better understand the risks survivors face, finding ways to reduce those risks and to better understand which survivors are at risk. The Survivors Facing Forward program at the Steven and Alexandra Cohen Children’s Medical Center of New York has focused on iron overload in survivors. Few, if any, centers that treat children for cancer track the number of blood transfusions children get while receiving treatment. This may be very important though, as each transfusion delivers a large dose of iron. Over time, the iron can build up and cause damage to various organs, including the heart and liver. We have found that 20% of survivors are in fact iron overloaded, and 11% have severe iron overload. The good news is that iron overload is relatively easy to treat – essentially just give blood! Additionally, our center has been developing databases that can track survivors over time, and has been working to develop a large, multi-center regional database with a DNA bank that will permit in-depth research to find ways to improve survivors’ wellness.