Complicated history: What happens when cancer survivors grow up?

Increasing numbers of adult patients are survivors of childhood cancers. For many, the health risks remain.

By Susan J. Landers, AMNews staff. July 7, 2003.

The high survival rate of children with cancer is one of medicine's greatest success stories. Before the 1970s, childhood cancers such as leukemia or brain tumors were considered almost certain death sentences. Today the vast number of young patients diagnosed will be cured.

The impact of these childhood experiences on patients' lives, both in terms of the cancers and their treatments, often echo through primary care physician offices, where thousands of adults with this background go for regular health care. Many have very special needs.

Sometimes these medical needs are aftereffects of the cancer itself; other times they're caused by the treatment. Organs can take a pounding when oncologists pull out all the stops to attack a child's cancer, and secondary cancers can occur years later.

Consider these examples: An adult patient who was treated years before for Hodgkin's disease should be screened for breast cancer much earlier because she received radiation in areas with healthy breast tissue. Other risks are heart disease after chemotherapy or high-dose chest radiation and learning disabilities after radiation or chemotherapy to the brain. Symptoms of posttraumatic stress disorder have been seen in survivors and their parents. Patients who received blood transfusions before July 1992 might have been infected with hepatitis C.

"The function of ... fairly aggressive therapy is there is almost always some kind of chronic or late effect that we worry about," says Julia Rowland, PhD, director of the National Cancer Institute's Office of Cancer Survivorship.