Adult survivors of childhood cancer
The current generation of adults is the first to grow up in the era of successful treatment for many childhood cancers. Nearly 300,000 American adults who are now in their 20s, 30s, and 40s enjoy CANCER-free, healthy lives. Doctors consider treatments for most types of LEUKEMIA, the most common childhood cancer, to be curative. Treatments for many types of BONE CANCER, BRAIN cancer, Hodgkin’s LYMPHOMA, and kidney cancer (WILMS’S TUMOR) are also curative. Some health concerns may linger or occur, however, as a result of the cancer itself or the therapies used to treat the cancer.
Complications of Cancer Treatment
Complications of cancer treatment are the most significant cause of later health concerns for adults who had cancer as children. Some therapies for cancer that were the standard of care 20 or 30 years ago presented significant health risks that survivors are now beginning to experience. For example, doctors now know the CHEMOTHERAPY drugs, notably anthracyclines such as doxorubicin, can cause HEART FAILURE that tends to show up 10 to 30 years after treatment. Chemotherapy drugs affect all rapidly dividing cells in the body and can have a significant effect on healthy cells notably in the endocrine system, affecting THYROID GLAND function, growth, PUBERTY, and FERTILITY. Radiation to the chest, such as to treat lymphoma, can damage the HEART, manifesting in adulthood as CARDIOMYOPATHY or heart failure. Radiation to the head or EYE can result in vision and hearing problems. Surgery, particularly AMPUTATION, may result in lifelong health issues that require regular medical attention.
Increased Risk for Another Cancer
Having had cancer increases the risk for developing another cancer later in life. For this reason, regular health screening for cancer is especially important for adults who had cancer as children. Radiation therapy and chemotherapy both increase the risk for leukemia and lymphoma, likely as a consequence of damage to the bone marrow during cancer treatment and especially chemotherapy. Radiation therapy to the upper body raises the risk for lung cancer, particularly when other risk factors for lung cancer exist such as cigarette smoking, and for breast cancer in women.
The emotional consequences of successful cancer treatment in childhood may be pervasive, with numerous effects people do not recognize as related to the cancer experience. Some studies show that adults who had cancer as children reexperience the range of emotions and fears that accompanied their cancer when as adults they enter medical environments for health care of any kind, often as a presentation of POST-TRAUMATIC STRESS DISORDER (PTSD). The reaction to the current situation may be out of proportion to the situation itself. Having survived a health crisis as serious as cancer as a child may have a profound effect on a person’s ability to engage in activities of life, manifesting as withdrawal in some people and in highrisk behaviors in others.
Maintaining a Balanced Perspective
It is important for adults who had cancer as children to maintain a balance between diligence and confidence when it comes to health matters. More often than not, subsequent health concerns arising from childhood cancer or its treatment are treatable and manageable, particularly with early detection. Many cancer treatment centers now offer follow-up services, including counseling, for adult survivors of childhood cancer.