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
"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."