Chasing Away Childhood Cancer

Long-Term Effects of Childhood Cancer

Childhood cancer is one of the biggest bullies we must stand up to for the sake of our children. Each day, over 43 children are diagnosed with this tragic disease, which means more families are left with their world turned upside down. In many cases, young patients diagnosed with this disease are required to undergo an aggressive form of treatment. Two-thirds of patients who experience this treatment will have long-lasting chronic conditions as a response to these medical methods.

Dr. Greg Armstrong is a pediatric oncologist for St. Jude Children’s Research Hospital. In regards to the long-lasting effects of pediatric cancer, Armstrong states that “Aggressive surgery, radiation therapy, and chemotherapy can all impact a patient’s risk for long-term health problems. For pediatric cancer patients, those therapies are applied to a developing body, which has many dividing cells that are especially vulnerable to damage from these harsh therapies. Late effects occur in many different body systems, depending on the site of the cancer and the treatment.”

After conducting a study to investigate the long-term effects of childhood cancer, Armstrong concluded that childhood cancer survivors from the 1990s are living longer than those diagnosed in the 1970s and 1980s. Armstrong states “The original study population of survivors diagnosed in the 1970s and the early 1980s taught us a lot about the toxicities of cancer therapies, which helped lead to a reduction in the use of these therapies for some cancers”

In regards to genetics playing a role in long-term effects, Armstrong explains that this notion is still under consideration. “We are collaborating with NCI’s Division of Cancer Epidemiology and Genetics (DCEG) to analyze the germline genetics of childhood cancer survivors. We have now analyzed genetic variants in the genomes of more than 5,700 survivors, and we currently have two genome-wide association studies investigating survivors’ genetic susceptibility to second cancers—specifically, breast cancer and a type of brain cancer called meningioma. Within the next year, DCEG will also complete whole-exome sequencing of those 5,700 participants, so it will be a pretty rich dataset.”

Armstrong has also conducted additional intervention studies for long-term effects of childhood cancer, such as the Advancing Survivors Knowledge (ASK) About Skin Cancer study. He states “The goal of the ASK study is to improve screening rates for skin cancer, because childhood cancer survivors are at a threefold greater risk for melanoma and 40-fold greater risk for non-melanoma skin cancer than the general population. The ASK study uses telemedicine to interact with participants, and participants have been very open to this approach. Another intervention trial, the EQUAL study, aims to reduce obesity in survivors of acute lymphoblastic leukemia.

The CCSS is also expanding the use of mobile health technology. We have 24,000 participants scattered across the country, so we’ll never be able to assess them all systematically in a clinical setting. To address this, we are collaborating with the Health eHeart Study at the University of California, San Francisco, to begin using cell phones to collect health-related data for the CCSS.

For example, in our surveys we ask if the participant has high blood pressure. Now we can send them blood pressure cuffs that connect to their phones and ask them to send us weekly blood pressure readings. Other sensors that can be linked to mobile phones—such as electrocardiogram monitors, weight scales, and physical activity monitors (like Fitbit)—can be used to capture data from survivors that are geographically dispersed across the country.

With our previous work and these new directions, the CCSS is poised to make a significant and lasting influence on the field of childhood cancer survivorship for years to come.”

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