The chances of curing a child with cancer have improved very significantly over the past 20 years or so, but we still have a lot more to do. Some children will have long term health problems as a result of their illness and therapy which will remain with them for the rest of their lives. I am very interested in these “late effects” and trying to find ways to make them less severe and less frequent.

Researchers from the St Jude Children’s Research Hospital recently published a study where they clinically assessed a large group of adult survivors of childhood cancer (over 1,700 patients). They found that at age 45, the estimated cumulative prevalence of any chronic health condition in these survivors was 95.5% and just over 80% had a serious, disabling or life-threatening condition. Adults treated for childhood cancer are far more at risk for late effects because they were still growing at the time of therapy and normal organ development was damaged. Also, we are starting to understand that with time, the risk of late effects is not static: survivors of childhood cancer are likely to live many years and with each passing year, the risk of a long term health problem increases.

In order to prevent late effects, we need to understand why these problems occur.  Using less intensive treatment is sometimes possible. Increasingly, we are learning that some people are far more vulnerable to damage than others because of their underlying genetic constitution. There is also emerging evidence that leading a healthy life style can help to reduce the risk of late effects. For example, if treatment has resulted in damage to the heart, then exercise, not smoking and a healthy diet has the potential to reduce the risk of progressive heart disease in childhood cancer survivors.

Currently, I am studying late effects in a group of long-term survivors of a type of brain tumor called a craniopharyngioma. I am working with a team to look at the different factors these patients might have which increase the risk of having a stroke many years after treatment.

My hope for the future is to expand this program to include survivors of other childhood cancers. Clinical care for survivors of childhood cancer at high risk for late effects can be linked with a research program to investigate physical and psychosocial chronic health problems. We can also aim to educate health care professionals and patients about late effects screening, therapy and prevention.

We’ve come a long way in understanding childhood cancer. Our goal now is to ensure every child has a chance at surviving their cancer and enjoying a long and healthy life ahead.

Thank you for reading my blog,

Karen

Director of Pediatric Radiation Oncology, Vancouver Centre