“We have an obligation to make sure the treatment we gave them didn’t harm them, and that we have measures in place to screen them for late effects of it,” Dandekar said. “Our entire focus is on empowering our patients by educating them.”
Long-term follow-up guidelines vary, depending on the specific type of malignancy a childhood cancer survivor experienced and the kind of treatment they received. Some cancer therapies may be linked to later cardiac, musculoskeletal, and pulmonary problems. For example, cardiac dysfunction isn’t unusual in children who needed chemotherapy that included anthracycline drugs for their cancer — and those youngsters should be screened with echocardiograms frequently.
In addition, certain treatments can up the risk for additional cancers so early detection is important. Children and teens who received radiation to the chest need to have regular breast cancer screenings; those who had radiation treatment to their abdomens may need early screenings for colon cancer.
While many kids grow up playing sports and being active, young cancer survivors often miss out on these health-building pursuits — and that can put them at risk for obesity and weak bones.
“During the time of life when they should have been active and playing and developing good physical habits, they were spending a lot of time being sick, being in therapy and in the hospital,” Dandekar explained.
Mental health screenings can be useful to help older children deal with any learning difficulties they have or problems adjusting to social situations. Children who have had chemotherapy or radiation to the spine or brain may have some cognitive impairment and can need extra help with academic challenges. What’s more, it’s not unusual for children to feel separated from other kids their own age due to their diagnosis and treatment - and that can trigger depression or anxiety.
After a childhood cancer survivor is 22 years old, or 10 years past any cancer treatments, all of his or her care is typically transitioned from an oncologist to a regular pediatrician or family doctor.
“They should not have to be followed by an oncology practice the rest of their lives,” Dandekar said. “The goal is that by the time they graduate from our program, they have enough education to be their own advocate.”
March 30, 2020
Christopher Nystuen, MD, MBA