Adult survivors of childhood cancer

Over the past 30 years medicine has made great progress in treating childhood cancers. Today about 80% of kids with cancer are cured. However, doctors have come to realize that many of the treatments used in the 1970s and ’80s to achieve a cure for a child’s cancer also caused long-term effects that may not become obvious until that person is much older.

Two recent studies reveal that the rate of late effects in childhood cancer survivors is quite high—about 75% of them had at least one chronic condition resulting from their treatment and 40% had a severe or life-threatening condition. This risk increases as a survivor gets older, and complications vary depending on the exact treatment he or she had as a child. Among the more common problems are breast cancer, heart disease, osteoporosis, and infertility.

Make sure your doctor knows
What can childhood cancer survivors do to minimize these risks? “The main thing is follow-up,” says Kevin Oeffinger, MD, director of the Program for Adult Survivors of Pediatric Cancer at Memorial Sloan-Kettering Cancer Center. “Make sure your current doctor knows your history so that he is aware of your risks.”

Mark Dickey, 40, who had Wilm’s tumor (a form of kidney cancer) when he was 2, has extensive records of his treatment. “I keep a binder that has every case note and every treatment I had,” he says. He adds to that any current medical records. If your records were not supplied by the hospital where you were treated, call and ask for copies. The records should be shared with your current doctor, who should communicate with the cancer center to coordinate screenings.

There is a great deal that childhood cancer survivors can do to head off severe complications. Avoiding tobacco is critical, since most cancer treatments weaken the organs that are affected by smoking. A diet rich in calcium (plus vitamin D) can help prevent osteoporosis. But the most important thing, notes Dr. Oeffinger, is exercise. “Thirty minutes of walking five times a week does a lot to counteract the effects of cancer treatment,” he says.

Terry Turman, who was diagnosed with Ewing’s sarcoma (a childhood cancer of the bones or soft tissue) more than 20 years ago, agrees. Shortly after his treatment at age 11 he began playing sports again, and he has been active ever since. “It started as wanting to prove the cancer didn’t affect me,” he says. “But now I see that it keeps me healthy.”

The cancer crucible
Turman also credits his cancer for changing him emotionally. “It made me stronger,” he says. “I think I grew up a lot faster than other kids, and it made me want to do good with my life.” Dr. Oeffinger says this resilience is common in people who faced cancer as a child.

Also common is recurring anxiety or depression at various points in life. Following up with emotional care is essential. “There are a growing number of counselors who deal with cancer survivors,” says Dr. Oeffinger. “A cancer center can usually help you connect with one.”
Above all, patients should empower themselves. “I know I’m more likely to have a second cancer or some other serious problem,” says Dickey. “But I try to stay on top of things and get myself checked out.”