By Admin at 19 Apr 2016, 14:50 PM

A great deal of progress has been made in the treatment of childhood cancer. Most children not only survive the most common childhood cancers but in many cases the disease can be cured. After the initial cancer is treated, however, the concern often turns to so-called “late” or lasting effects of treatment

The powerful treatments used to kill cancer cells can damage healthy cells as well, leading to a wide range of health effects both in the immediacy and days, months or even many years down the road. Children are particularly vulnerable to late side effects, especially from chemotherapy and radiation treatments. Some of the more common late effects of cancer treatment include:

• Heart or lung problems
• Slowed or delayed growth and development
• Changes in sexual development and ability to have children
• Learning problems
• Increased risk of cancer later in life

Fortunately, improvements in cancer treatments and follow-up care have reduced deaths from late effects of cancer treatment—and childhood cancer survivors are now living longer, healthier lives.

Researchers from St. Jude Children's Research Hospital used data from more than 34,000 childhood cancer survivors diagnosed and treated between 1970 and 1999. The 15-year death rate among the participants declined steadily, from over 12 percent in the early 1970s to 6 percent in the 1990s.

Deaths from late treatment effects (such as second cancers, heart problems or lung problems) also decreased, from 3.5 percent to 2.1 percent, during the same period. The decrease is due at least in part to changes in pediatric cancer care, including reductions in the use and dose of radiation therapy and chemotherapy drugs. For instance:

• Rates of cranial radiotherapy for acute lymphoblastic leukemia fell from 85 percent in the 1970s to 19 percent in the 1990s
• Abdominal radiotherapy for Wilms' tumor fell from 78 percent in the 1970s to 43 percent in the 1990s
• Chest radiotherapy for Hodgkin's lymphoma fell from 87 percent to 61 percent
• Anthracycline exposure was reduced (this class of drugs increases the risk of cancer, heart failure and other health problems later in life

 
Study author Greg Armstrong, M.D., associate member of the Department of Epidemiology and Cancer Control, told Science Daily:

"This study is the first to show that younger survivors from more recent treatment eras are less likely to die from the late effects of cancer treatment and more likely to enjoy longer lives …

The results are a testament to the physicians and scientists who in the past 30 years took a calculated risk of developing new protocols that used less intense therapies that reduced the risk of late effects and maintained excellent five-year survival.”

Changes in follow-up care have also benefitted childhood cancer survivors. For instance, those who received chest radiation may be closely monitored for the development of breast cancer while those exposed to anthracyclines may be monitored for heart problems. Early detection of late effects “may make a lifesaving difference,” Armstrong noted.

Sources:
New England Journal of Medicine March 3, 2016
Science Daily January 13, 2016
American Cancer Society

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