Stories about: Lisa Diller

Cancer treatment and fertility: Acting now to have children later

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(Sebastian Kaulitzki/Shutterstock)

With over 75 percent of children diagnosed with cancer surviving into adulthood, more and more parents ask questions about the quality of life survivors can expect in the future, including: Will my child be able to have children down the road?

They’re right to be concerned. The therapies that are so effective at saving children’s lives can themselves cause a host of problems that don’t manifest until years later. These late effects of cancer treatment include particularly harsh impacts on fertility.

“Cancer treatment impairs ovarian function by reducing the number of eggs in them,” says Elizabeth Ginsburg, MD, a fertility specialist at Brigham and Women’s Hospital who collaborates with Lisa Diller, MD, the chief medical officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “It’s as though it pushes the ovaries further down the age curve. So while a woman who has survived childhood cancer may be 20 years old, her ovaries act like they’re 35 or 40.”

Boys are not exempt from these concerns. “Boys are at the same relative risk for infertility due to treatment,” says Richard Yu, MD, PhD, who works on male infertility in the Boston Children’s Department of Urology. “The same chemotherapy and radiation treatments that affect the ovaries can also wipe out the sperm stem cells in the testes.” …Read More

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What’s on the horizon for childhood cancer

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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.

But 80 percent isn’t good enough, and there’s still a lot of work to do. For Childhood Cancer Awareness Month, Lisa Diller, MD—chief medical officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center—looks ahead to what she sees as the four biggest trends in pediatric cancer research and care:

  • 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. “

Read the details of Diller’s thoughts about the future of pediatric oncology.

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Tips when caring for childhood cancer survivors

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As more and more children survive cancer, it is estimated that 1 in 300 young adults is a childhood cancer survivor. These survivors are returning in ever-greater numbers to their primary care providers (PCPs) for their ongoing care. PCPs may be challenged in caring for these survivors, because they were treated with many different therapies associated with rare, but significant, complications or “late effects.”

Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s and medical director of the David B. Perini, Jr. Quality of Life Clinic, spoke to MedPageToday about her five top tips for adult or family PCPs managing the care of adult patients who survived childhood cancer.

Below, Diller and Peter Manley, MD,a Dana-Farber/Boston Children’s neuro-oncologist and director of the Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic, share their recommendations for pediatricians seeing cancer survivors who are still in their childhood or adolescent years. …Read More

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