Health Problems Common in Survivors of Pediatric Cancer

Pediatric cancer treatment has come a long way, but health problems persist in survivorship.
Nick Dustman of Jacksonville, Fla., was 16 when he had a lump removed from under his right ear. Earlier, two doctors had dismissed family concerns that the lump might be something serious. When the pathology report showed the cells to be atypical, the sample was sent to St. Jude Children’s Research Hospital in Memphis, Tenn., where Dustman received a diagnosis of Hodgkin lymphoma, a cancer of the immune system that accounts for about 4 percent of all childhood cancers.

Five years after receiving radiation treatment to the chest and neck at St. Jude, Dustman was declared cancer-free.

Decades later, however, the specter of Dustman’s treatment reappeared as breathing difficulties. A long-time athlete, Dustman found it increasingly difficult to catch his breath while exercising. His doctor suspected asthma and prescribed an inhaler, which proved ineffective.

“One day, during a run in Baltimore, my breathing became painful, and I had difficulty getting enough air,” Dustman recalls. “I thought I was developing fibrosis of the lungs, which I knew was a potential side effect of radiation treatment.”

Dustman, only partially correct, learned that his health issues were indeed related to his cancer treatment, but it wasn’t fibrosis—he had developed angina from radiation-related coronary artery disease. The diagnosis was confirmed at St. Jude in 2009 when Dustman returned for the St. Jude LIFE Study, the hospital’s ongoing childhood cancer survivorship research program.

“I ended up having a six-vessel cardiac bypass,” Dustman says. “The doctors told me that when you look at my clinical report, you can see exactly where the radiation had penetrated—it was in very specific patterns.”

Dustman, now 45 and a sales director for a pharmaceutical company, is among the estimated 395,000 survivors of childhood cancer living in the U.S. He’s also one of more than 2,400 former childhood cancer patients to date who have taken part in the St. Jude LIFE Study, the first large population of survivors to be evaluated using a comprehensive systematic clinical assessment to determine the prevalence of chronic health outcomes.

Following the children long-term has not only given the oncology community a glimpse of the late effects of their treatment and how better to prepare patients, it has also impacted the way children are treated today, says Melissa M. Hudson, director of the cancer survivorship division at St. Jude.

Hudson is the lead author of a recent report appearing in the Journal of the American Medical Association (JAMA) regarding health outcomes among adults treated for childhood cancer. In the St. Jude cohort of 1,713 survivors, 98 percent had at least one chronic health condition. And of that number, an estimated 68 percent had health issues that could be considered serious, disabling or life-threatening.

Cheryl Moring, 51, of New Edinburg, Ark., is also participating in the study. She developed an unusual growth behind her ear at age 5 in 1967. At St. Jude, doctors diagnosed her condition as acute lymphoblastic leukemia and told her parents she had six months to live.

Talk about this article with other patients, caregivers, and advocates in the Childhood Cancers CURE discussion group.
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