• Childhood Cancers: Long-Term Effects of Treatment

    image for cancer in children article All medical treatments have both benefits and potential harms. This may be more true for cancer treatments than for other medical therapies. Some cancer treatments have late effects even after they have led to a cure. This is especially true for childhood brain cancer and leukemia. Now that childhood cancer survivors are living longer, researchers are beginning to learn more about the possible long-term (late) effects of childhood cancer treatments.
    Your child’s doctor will make every effort to select treatments that will minimize future risks, as well as discuss what you and your child can expect. This article will acquaint you with some topics that might come up in such a discussion. It is important to keep the possible late effects of cancer treatment in perspective.

    Late Effects of Treatment

    In most cases, cancer treatment involves surgery, and/or chemo- or radiation therapy. For some cancers, treatment may also include a stem cell transplant. Radiation therapy uses high-energy rays to kill or shrink cancer cells, while chemotherapy uses one or more drugs. A stem cell transplant replaces damaged stem cells in the bone marrow with new ones from a donor. The stem cells will produce healthy red and white blood cells, and platelets. Late effects from chemo- and radiation therapy include second cancers and fertility problems. If a stem cell transplant was needed in addition to other treatments, some late effects can be more severe.
    Children who have been successfully treated for childhood cancer face a small but increased risk of developing a second cancer—of an entirely different kind—during their lifetime. Scientists still don’t completely understand second cancers and they currently have no way of predicting which children are susceptible and which children are not. This risk may diminish in the future as doctors use new cancer treatments specifically designed to minimize the development of second cancers.
    While most childhood cancer survivors are able to have children, fertility problems can still occur due to cancer treatment. Chemo- and radiation therapy affect pregnancy rates more than other treatments. Treatment may lower sperm count in boys, while ova may be affected in girls. Males are more likely to have fertility problems.Your child's age during treatment may also have an effect. For example, boys who have not reached puberty are less likely to be affected by fertility issues than boys who have.
    If your child has gone through puberty and is facing cancer treatment, there are ways to preserve fertility in advance. For boys this may include sperm banking, the process of collecting and freezing sperm samples for the future, and organ shielding during radiation treatment. In girls, this may include egg freezing, hormone treatments, organ-saving surgical procedures, and organ shielding. Cancer treatments can also delay puberty in both boys and girls.
    Your child's doctor can advise you whether your child’s treatment has a significant chance of affecting fertility. However, if any genetic material from testicular or ovarian tissue is damaged, the risk of abnormalities with your children may be higher.
    In general, children born to survivors of childhood cancer are not affected by their parent’s history of cancer treatment.
    It is important to discuss options before your child starts treatment.

    Late Effects Associated With Brain Cancer

    Reducing the complications of treatment for brain cancer, which often involves surgical removal of a tumor followed by radiation therapy to the brain and/or spinal column, remains a serious challenge for children, parents, and doctors. While treatment breakthroughs are anticipated, complications after current treatments of brain cancer are both more frequent and more troublesome than with many other cancers. Be sure to have your child’s doctor explain the kinds of complications that may be expected following treatment for brain cancer and the efforts that will be made to minimize them. Some of the late effects that do occur after treatment for brain cancer include:
    • Changes in behavior and school performance
    • Changes in growth rate and sexual maturation
    • Endocrine problems, which can create hormone imbalances

    Neurocognitive Effects

    As mentioned above, survivors of brain cancer usually experience trouble with school performance. Children who undergo chemotherapeutic treatment for leukemia or other cancers may also experience neurocognitive problems. You may notice your child having trouble with learning, paying attention, or keeping up with classmates.
    As doctors become more aware of the potential for neurocognitive problems, they are taking steps to identify children who may be affected, and to make sure they receive appropriate educational support. Early identification and support can help your child cope with and overcome these challenges.
    In addition, some medical treatment centers are developing techniques to deliver radiation therapy that aim to minimize or even eliminate late effects in children with brain cancer, without compromising the effectiveness of treatment.

    Emotional Effects of Cancer and Cancer Treatment

    In today’s cancer centers for children, doctors and nurses make efforts to reduce the pain and fear associated with cancer. Despite these efforts, cancer is a frightening disease, and its treatment is rarely without some discomfort. Despite the best medical and nursing care, some survivors of childhood cancer find that memories and anxiety associated with cancer keep intruding into their lives, even years after treatment is finished. When fears and memories return frequently and intensely, psychologists may make a diagnosis of post-traumatic stress disorder (PTSD). PTSD may even occur in some children who are cured of cancer.
    In an effort to help your child from developing PTSD, the oncology staff will likely want to talk with your child about their feelings. Many centers use play therapy so that younger children can express feelings of fear or anxiety. If you find your child continues to worry about cancer or to have disturbing memories or dreams about the treatment process, talk with your doctor about getting psychological help, which may prevent the late development of PTSD.

    Cancer and Hope

    Today, cure is a realistic outcome for most children with cancer, and with more awareness about late effects of treatment, you and your child will be better prepared to handle them if they arise. Even though worrying about future complications is understandable, these concerns should not take precedence over potentially curative treatment decisions. Be sure, however, to ask questions about long-term risks and how they can be minimized. Keep precise records of what treatments your child received and when. And find a doctor that is capable of creating a trusting, long-term relationship with your child. Your child will need to depend on someone other than you when facing the challenges that lie ahead.

    RESOURCES

    American Cancer Society http://www.cancer.org

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca

    Cancer Care Ontario https://www.cancercare.on.ca

    References

    Childhood cancers (treatment). National Cancer Institute website. Available at: http://www.cancer.gov/types/childhood-cancers. Updated May 13, 2015. Accessed December 7, 2015.

    Children diagnosed with cancer: late effects of cancer treatment. American Cancer Society website. Available at: http://www.cancer.org/treatment/childrenandcancer/whenyourchildhascancer/children-diagnosed-with-cancer-late-effects-of-cancer-treatment. Updated February 17, 2014. Accessed December 7, 2015.

    Female delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2013. Accessed December 7, 2015.

    Gurney JG, Kadan-Lottick NS, Packer RJ, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors. Cancer. 2003;97(3):663-673.

    Kamibeppu K, Murayama S, Ozono S, et al. Predictors of posttraumatic stress symptoms among adolescent and young adult survivors of childhood cancer: importance of monitoring survivors' experiences of family functioning. J Fam Nurs. 2015;21(4):529-550.

    Late effects of treatment for childhood cancer (PDQ). National Cancer Institute website. Available at: http://www.cancer.gov/types/childhood-cancers/late-effects-pdq. Updated October 30, 2015. Accessed December 7, 2015.

    Male delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2012. Accessed December 7, 2015.

    Morgan ER, Murphy SB. Care of children who are dying of cancer. NEJM. 2000;342(5):347-348.

    Rourke MT, Hobbie WL, Schwartz L, Kazak AE. Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatr Blood Cancer. 2007;49(2):177-182.

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