Survivors of pediatric cancer can face many increased risks — second cancers, heart disease, fertility loss, etc. — depending on the kind of cancer they were treated for and the treatments that were used.
“I think this paper raises this issue as one for awareness in the clinical setting and for future study,” said Lynda Vrooman, MD, a pediatric oncologist and cancer survivorship specialist with the Hematologic Malignancy Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “There are not, that I am familiar with, currently guidelines that inform recommendations for screening for autoimmune disorder in survivors or current clear strategies for reducing risk. This paper raises this as an issue for awareness moving forward and for further investigation.”
Cancer affects more than just the tissue or organ in which a tumor starts — it affects the whole patient. This is as much the case with children as adults, if not more so, and can have greater consequences. With survival rates for childhood cancers constantly on the rise, the long-term effects of cancer care on nearly every organ system are coming under increasing scrutiny, as are ways of reducing those effects.
A multidisciplinary approach to cancer care is the best way to keep cancer treatment’s side effects as low as possible while keeping a patient’s quality of life high, both during and after treatment. In this context, pediatric urologists bring a unique perspective, one that combines techniques that can help a child’s care team evade or alleviate continence and voiding issues during treatment and address options for maintaining urologic, sexual and reproductive function down the road.
As I walked into the inpatient pediatric oncology waiting area at Yangon Children’s Hospital—a relatively modern, well-equipped hospital in Yangon, Myanmar—a beautiful young woman approached me. She was holding her son, a 15-month-old boy who had Down syndrome. In English, she repeatedly sobbed, “Please help me.”
An interpreter explained that she and her husband were farmers from rural northern Myanmar (more than 700 miles from Yangon, an urban area of more than 5,000,000 people) and that recently their son had not wanted to breast feed, had been sleeping a lot and had developed lumps in his neck. They had previously traveled to Thailand, where their son was diagnosed with acute lymphoblastic leukemia (ALL). The parents had sold their farm to travel to Yangon so their son could receive chemotherapy.
I smiled and put my arm around her but could not think of what to say that would give her comfort. It was my first day at Yangon Children’s and my first experience in my yearlong global health nursing fellowship with Boston Children’s Hospital’s Global Health Program. With this single chance meeting in the waiting area, it took all of 15 minutes for me to begin to understand the challenges that families and medical staff in Myanmar face in providing quality, consistent health care. …Read More
Pediatric oncology is a rapidly evolving field. Just look at the last 40 years, during which childhood cancer has changed from a certain death sentence to a condition where some 80 percent of patients survive.
Precision medicine: “Treatment for cancers is now being transformed because we can genetically characterize an individual’s tumor, finding genetic changes that suggest specific targeted therapies.”
Immunotherapy: “Already there have been dramatic advances in melanoma outcomes and promising results in other adult-onset cancers. We are beginning to learn how to use this approach in pediatric cancers.”
Reducing toxicity: “Since the late 20th century, we have increasingly sought ways to reduce the toxicity of treatment to maintain cure rates with fewer late effects. These efforts will continue.”
Global health: “Because pediatric cancers are rare, pediatric oncology is a global community accustomed to collaborating internationally, which offers a good platform for a stronger focus on improving survival of childhood cancer globally. “