Childhood Cancer

Protecting Kids’ Hearts While Fighting Their Cancer

by St. Baldrick's Foundation
February 13, 2019

It’s Valentine’s Day and that means exchanging cards, chocolates, teddy bears, and flowers with loved ones. The prevailing symbol of Valentine’s Day is the heart – which makes sense, given that the day is all about showing love and affection.

Because the heart is so central to Valentine’s Day, it’s a useful time to reflect on how childhood cancers impact this vital organ. Unfortunately, childhood cancers affect far more than the parts of the body in which they emerge – brain cancer doesn’t just harm the brain; leukemia doesn’t just affect the blood; and bone cancers often spread to the major organs.

Photograph of Abby Furco, former St. Baldrick's Ambassador.

Health Problems Rooted In Childhood Cancer

It’s part of the simple and unfortunate truth that, for many kids who experience cancer, the fight doesn’t end when their cancer has been defeated. In fact, virtually all survivors will grapple with some health issue resulting from having childhood cancer.

Few body parts are affected by childhood cancer more than the heart. The cardiovascular system, which is central to the body’s overall health, is directly affected by every sleepless night, every round of chemotherapy, every new powerful medication, every invasive surgery. For many children fighting cancer, each day is a war with their disease, and over time that puts incredible pressure on the heart.

It could be decades before the heart begins to show signs of wear stemming from a prolonged fight with childhood cancer. Or, it could be much sooner, with some childhood cancer survivors experiencing heart issues in their twenties and thirties.  Nevertheless, for a childhood cancer survivor, it’s a scary thought to know that they may eventually face a new foe in the form of heart disease.

It’s a concern that 19-year-old Zoe, a childhood cancer survivor, reflected on in a blog post for St. Baldrick’s last year. “Being a survivor means that I will never be as physically healthy as someone who never had childhood cancer,” Zoe wrote. “I have dealt with, or will deal with, learning disabilities, infertility, a high risk for secondary cancers and organ failure, and a heart that must work harder than usual to pump the blood I need.”

Like Zoe, 12-year-old Abby, a former St. Baldrick’s Ambassador, has faced significant heart problems since her diagnosis with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL) eight years ago. The chemotherapy Abby subsequently received seriously damaged her heart – to the point where she experienced heart failure. Not only did this leave Abby terribly weak, but it threatened to prevent her from receiving a much-needed bone marrow transplant (BMT).

Thankfully, Abby responded well to Carvedilol, a drug studied by researchers funded by St. Baldrick’s, and she was able to safely undergo her BMT. Today, while Abby is in remission and her heart is performing well, there’s a chance she’ll need a heart transplant in the future. Nevertheless, her mom, Patty, is optimistic about her daughter’s condition as well as research funded by St. Baldrick’s seeking less damaging childhood cancer treatments.

“We are so thankful to have Abby with us today! We find great hope in Abby’s future because of the many researchers working on developing treatments to help with the side and late effects of chemotherapy and lessening the toxicity of current chemotherapy options,” Patty said.

Looking ahead, Patty says Abby is excited about returning to some of her favorite activities.

“She is currently cancer-free and eventually she will go back to school,” Patty said. “That will be huge for her.”

Childhood Cancer Survivor Faces Heart Surgery at 35

Dr. Greg Aune, a pediatric oncologist and winner of a St. Baldrick’s Scholar Award, is especially familiar with heart conditions stemming from childhood cancer treatments. As a teenager, Dr. Aune was diagnosed with Hodgkin lymphoma and underwent extensive radiation and chemotherapy.

While Dr. Aune survived his cancer, at age 35 he faced a whole new but entirely related health threat: emergency heart surgery. He survived that challenge too, but it required extensive time away from his work to fully recover.

The good news is that Dr. Aune, along with many others in the pediatric cancer community, recognize this threat and are taking action to help childhood survivors manage heart problems. For his part, Dr. Aune responded to his own health scare by shifting his research to focus more on how pediatric cancer treatments impact the heart and what changes can be made to alleviate pressure on the cardiovascular system.

“Could I use this [experience] to develop therapies that might protect the heart?”, Dr. Aune asked himself. “Or to develop models that would help us understand better how chemotherapy damages the heart?”

Thanks in part to funding from St. Baldrick’s, Dr. Aune is busy at UT Health San Antonio studying these questions. Specializing in pediatrics and hematology-oncology, he’s active in several organizations dedicated to childhood cancer research and improving outcomes for children who survive cancer. And his research investigating less damaging cancer treatments for children is showing promise.

“We now have promising preclinical results that will provide justification for clinical trials using different chemotherapies with similar ability to kill cancer cells, while being less toxic to the heart and cardiovascular system,” Dr. Aune said.

St. Baldrick’s Researchers Search for Less Toxic Treatments

Dr. Aune isn’t alone in studying how traditional cancer treatments impact kids’ hearts. Another St. Baldrick’s researcher, Dr. Eric Chow, is also on the case. At the Fred Hutchinson Cancer Research Center in Seattle, Dr. Chow is examining how widely used chemotherapy drugs put some childhood cancer survivors at risk for heart attacks and arteriosclerosis (the thickening of blood vessels), as well as heart failure.

“In general, people who got higher doses of anthracycline chemotherapy or higher doses of radiation, or both, are going to have a higher risk of heart failure, meaning their heart doesn’t pump well enough and blood and fluid backs up,” Dr. Chow said.

But what do you do when these chemotherapy and radiation treatments are effective? How can you advise against using a treatment to save a child’s life today just because it might prove dangerous in the future?

The answer, Dr. Chow believes, involves finding methods to protect a child’s heart during cancer treatment. With the support of St. Baldrick’s, he’s investigating the drug dexrazoxane. To determine whether this drug is beneficial, he’s following childhood cancer survivors who received chemotherapy either alone or in conjunction with dexrazoxane while on clinical trials in the 1990s.

With St. Baldrick’s support, Dr. Chow and colleagues are also pursuing a clinical trial that uses physical activity tracking technology to improve health outcomes among adolescent childhood cancer survivors.

Looking ahead, Dr. Chow believes we all need to do a better job of monitoring the overall health of childhood cancer survivors. “There are more and more people who are surviving their cancers and telling us and telling the community, ‘Hey, I survived, but not everyone is thriving,’” Dr. Chow said.

“That’s an important message – that we need to do better.”

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