Survivors of Childhood Cancer Face Other Medical Risks As Adults

The treatment of childhood leukemias and lymphomas is one of modernoncology's major success stories. Today, 80% to 85% of childhoodcancer patients grow up free of their disease. But the very treatmentthat, in most cases, cured these young patients leaves many ofthem at risk for other problems later in life.

"A survivor of childhood cancer is still not out of the woods,even though he or she may have been cancer-free for 5, 10, oreven 15 years," said Frederick Ruymann, MD, professor ofpediatrics at Ohio State University's Comprehensive Cancer Center.

"It's imperative that these individuals receive regular follow-upexams for the rest of their lives," said Ruymann, who isbased at Children's Hospital in Columbus.

The potential problems facing childhood cancer survivors can varywith the treatment used to cure their cancer. This may includeproblems during pregnancy for women treated with a particulardrug for leukemia, learning disabilities for those treated withradiotherapy to the brain, and an underdeveloped thyroid followingradiation therapy.

"In general, I'm not worried about acute lymphocytic leukemiarecurring in a child treated 10 years ago-there is a statisticalchance that might happen, but it's unusual in a patient of standardor intermediate risk."

"But I am concerned about how those patients who receivedcranial irradiation are doing in school. And I wonder about theyoung woman who received anthracycline for her osteosarcoma whenshe was 16 years old, and how she is doing in her pregnancy."

Survivors of Hodgkin's disease also are at significantly higherrisk of developing second cancers, he said.

For these reasons, it's important that survivors of childhoodcancer receive regular exams by a physician knowledgeable in long-termfollow-up, said Ruymann.

NCI-Sponsored Study to Clarify Risks

To help learn more about the risks faced by the survivors of childhoodcancer, the National Cancer Institute is sponsoring the ChildhoodCancer Survivors Study (CCSS). The study will involve 20,000 cancersurvivors, now age 20 to 40. The patients are being invited bytheir oncologists to participate.

The study is being conducted at 23 children's hospitals aroundthe nation, including Children's Hospital in Columbus, where Ruymannis the primary investigator for the study.

"This is an extremely exciting and important study,"he said. "We need to identify in a controlled way what delayedeffects of treatment these patients are experiencing. With thatinformation, we can develop methods to control those effects andimprove the potential for these patients to live a full life."

The study should also produce specific recommendations and guidelinesthat will help obstetricians and family physicians monitor theirpatients who are survivors of childhood cancer.

Such information will be important because survivors of childhoodcancer are a growing segment of the population. "By the year2000, one in 900 people under age 45 will be a survivor of childhoodcancer," said Ruymann. "By the year 2015, the numbercould be one in 500, and that's a lot of people."