Health of childhood cancer survivors is still at risk

AS YOUNG survivors of the modern era of cancer treatment enter the third and fourth decades of their lives, they find themselves poster children for the hope of medical progress -- and also for the toll taken by cancer's toxic treatments.

The cure rate for childhood cancer is one of 20th century medicine's greatest success stories. Before 1970, few children with cancer made it. Today, nearly 80% of children who have cancer are cured, according to the American Cancer Society's 2008 statistics. Of the 11 million American cancer survivors, 270,000 have survived childhood cancer.

But they have not survived unscathed.

In a kind of cosmic kick in the pants, the treatment that once saved them can put their health at risk for the rest of their lives.

Cancer therapies injure, starve or kill healthy cells along with malignant ones, and as a consequence, survivors have a heightened risk of health problems, including early heart attacks, second cancers, stunted growth and infertility.

"It really hits home when you see a young adult who comes in with congestive heart failure because of their radiation exposure," says Dr. Jacqueline Casillas, pediatric oncologist and director of the UCLA-Livestrong Survivorship Center of Excellenceat Mattel Children's Hospital.

The developing brain -- and psyche -- can be affected as well. Radiation to the brain can result in a drop of 20 or more IQ points, causing learning disabilities for some. And while some cured youngsters enter adulthood feeling a renewed sense of purpose, others must deal with lingering bitterness and trauma from their treatment, which can emerge as depression or anxiety when they become adults.

Doctors are using the experiences of these young survivors to try to make things better for new generations of pediatric cancer patients. They are also coming to realize they must do better by young people whose cancer lies behind them. Only recently is the medical community understanding the importance of lifelong health monitoring to help them avoid, or detect early, the host of medical risks that could lie in their path.

That often isn't easy. By the time the consequences hit, many young survivors have worked hard to forget the cancer experience. "Some survivors of childhood cancer, when they become adults, don't ever want to see another doctor again," says Anne Kazak, director of the department of psychology at the Children's Hospital of Philadelphia.