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Survivors of Childhood Cancer Face Other Medical Risks As Adults

Survivors of Childhood Cancer Face Other Medical Risks As Adults

The treatment of childhood leukemias and lymphomas is one of modern oncology's major success stories. Today, 80% to 85% of childhood cancer patients grow up free of their disease. But the very treatment that, in most cases, cured these young patients leaves many of them 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, or even 15 years," said Frederick Ruymann, MD, professor of pediatrics at Ohio State University's Comprehensive Cancer Center.

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

The potential problems facing childhood cancer survivors can vary with the treatment used to cure their cancer. This may include problems during pregnancy for women treated with a particular drug for leukemia, learning disabilities for those treated with radiotherapy to the brain, and an underdeveloped thyroid following radiation therapy.

"In general, I'm not worried about acute lymphocytic leukemia recurring in a child treated 10 years ago-there is a statistical chance that might happen, but it's unusual in a patient of standard or intermediate risk."

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

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

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

NCI-Sponsored Study to Clarify Risks

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

The study is being conducted at 23 children's hospitals around the nation, including Children's Hospital in Columbus, where Ruymann is 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 delayed effects of treatment these patients are experiencing. With that information, we can develop methods to control those effects and improve the potential for these patients to live a full life."

The study should also produce specific recommendations and guidelines that will help obstetricians and family physicians monitor their patients who are survivors of childhood cancer.

Such information will be important because survivors of childhood cancer are a growing segment of the population. "By the year 2000, one in 900 people under age 45 will be a survivor of childhood cancer," said Ruymann. "By the year 2015, the number could be one in 500, and that's a lot of people."

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