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
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.”
Looking back over the last half a century—maybe not even that long—one can see how the conversation about treatment in pediatric oncology has evolved. It used to be that survival rate was the primary, maybe only, concern among pediatric oncologists. How can we help more children and achieve more cures?
Fast forward to today. With experience and experiment has come greater knowledge of the biology underlying many solid, neurological and hematologic malignancies. That knowledge has, in turn, opened opportunities to reduce the long-term toxicity of cancer treatment and improve survivorship along with survival. How can we help more children survive, and survive better?
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.”