Surviving Childhood Surviving Childhood Cancer: What’s Next?Cancer: What’s Next?

Trisha KinnardTrisha Kinnard

PAS 646PAS 646

• ~ 1 in every 350 people in the US will ~ 1 in every 350 people in the US will develop cancer before the age of 20develop cancer before the age of 20

• In the 1960’s researchers found new In the 1960’s researchers found new therapies with combining therapies with combining chemotherapy drugs, radiation, and chemotherapy drugs, radiation, and surgery.surgery.

• These therapies have resulted in an These therapies have resulted in an increased number of patients with increased number of patients with sustained remission and cures.sustained remission and cures.

• More than 80% are expected to be long-More than 80% are expected to be long-term cancer survivors.term cancer survivors.

Chart from www.stjude.org/ltfuChart from www.stjude.org/ltfu

What are the What are the disadvantages?disadvantages?

• Physical ImpairmentsPhysical Impairments

• Emotional ImpairmentsEmotional Impairments

• Cognitive ImpairmentsCognitive Impairments

• Healthcare Healthcare – Lack of knowledgeLack of knowledge

Physical ImpairmentsPhysical Impairments

• Second malignanciesSecond malignancies• Immune system suppression and infectious diseaseImmune system suppression and infectious disease• Endocrine deficienciesEndocrine deficiencies• Cardiac impairmentsCardiac impairments• Cardiovascular diseaseCardiovascular disease• Sensory lossSensory loss• Genitourinary disordersGenitourinary disorders• Musculoskeletal abnormalitiesMusculoskeletal abnormalities• InfertilityInfertility• Physical performancePhysical performance• OsteoporosisOsteoporosis• ObesityObesity• DiabetesDiabetes

Emotional and Cognitive Emotional and Cognitive ImpairmentsImpairments

• Posttraumatic Stress DisorderPosttraumatic Stress Disorder

• Suicidal ideationSuicidal ideation

• Social impairment: family, friends, Social impairment: family, friends, relationshipsrelationships

• Intellectual and reasoning skillsIntellectual and reasoning skills

• Education level obtainedEducation level obtained

Purpose of the Childhood Purpose of the Childhood Cancer Survivor StudyCancer Survivor Study

• Opportunity: to gain knowledge about the Opportunity: to gain knowledge about the long term effects of both cancer and therapy, long term effects of both cancer and therapy, which can be used to form new treatments which can be used to form new treatments and to help with intervention strategies that and to help with intervention strategies that will hopefully increase survival and decrease will hopefully increase survival and decrease the amount of harmful late effects.the amount of harmful late effects.

• Obligation: through research, providers will Obligation: through research, providers will be able to educate patients about how their be able to educate patients about how their cancer diagnosis and treatment may affect cancer diagnosis and treatment may affect their long-term health and can help providers their long-term health and can help providers use the appropriate follow-up care for each use the appropriate follow-up care for each survivor, such as implementing proper survivor, such as implementing proper prevention and early detection programs to prevention and early detection programs to monitor late effects.monitor late effects.

Late effect examplesLate effect examples

• CNS tumors: physical, emotional, & cognitive CNS tumors: physical, emotional, & cognitive impairments (esp if treated <3 YO)impairments (esp if treated <3 YO)

• Secondary malignancies: 3-5% risk 20-25 Secondary malignancies: 3-5% risk 20-25 year after initial diagnosis, which is 3- to 6-year after initial diagnosis, which is 3- to 6-fold increased risk compared to non-fold increased risk compared to non-childhood cancer survivorschildhood cancer survivors

• Post-puberty females: more likely to have Post-puberty females: more likely to have infertility issues than pre-puberty because of infertility issues than pre-puberty because of fewer follicular storesfewer follicular stores

Patient EducationPatient Education• Promote a healthy lifestyle in childhood Promote a healthy lifestyle in childhood

cancer survivors because of their increased cancer survivors because of their increased risk of disease due to their cancer and late risk of disease due to their cancer and late effectseffects

• First, discuss adverse effects of risky First, discuss adverse effects of risky behaviors (i.e. smoking) and address the behaviors (i.e. smoking) and address the topic as if patient did not have cancer so topic as if patient did not have cancer so they can relate to their peersthey can relate to their peers

• Second, discuss how survivors are at higher Second, discuss how survivors are at higher risk for health problemsrisk for health problems

• Intervention groups have been shown to Intervention groups have been shown to raise awareness between risky behavior and raise awareness between risky behavior and poor health and to decrease numbers of poor health and to decrease numbers of people partaking in risky behaviorpeople partaking in risky behavior

Responsibility of the Responsibility of the SurvivorSurvivor• Summary of Cancer TreatmentSummary of Cancer Treatment

– Name of disease, date of diagnosis, site/stage of Name of disease, date of diagnosis, site/stage of disease, relapses, date of treatment completiondisease, relapses, date of treatment completion

– Names and phone numbers of hospital(s)/clinic(s) where Names and phone numbers of hospital(s)/clinic(s) where treatment was received and oncologist(s)treatment was received and oncologist(s)

– Name of all chemotherapy medicines received and Name of all chemotherapy medicines received and specific information about certain chemotherapy drugs, specific information about certain chemotherapy drugs, such as dose and route of administrationsuch as dose and route of administration

– Radiation therapy summaryRadiation therapy summary– Name and dates of surgeries patient has hadName and dates of surgeries patient has had– Whether patient received a hematopoietic cell Whether patient received a hematopoietic cell

transplant (bone marrow, cord blood or stem cell transplant (bone marrow, cord blood or stem cell transplant), and if so, whether or not patient developed transplant), and if so, whether or not patient developed chronic Graft-versus-Host Diseasechronic Graft-versus-Host Disease

– Names of any other cancer treatments that patient Names of any other cancer treatments that patient received (such as radioiodine therapy or received (such as radioiodine therapy or bioimmunotherapy)bioimmunotherapy)

– Names and dates of any significant complication(s), and Names and dates of any significant complication(s), and treatments received for complication(s)treatments received for complication(s)

Role of PCP/PARole of PCP/PA

• Educate ourselves about late effects of cancer Educate ourselves about late effects of cancer treatments (do not focus on just age-appropriate treatments (do not focus on just age-appropriate health maintenance)health maintenance)

• Be aware of the Be aware of the Long-Term Follow-Up Guidelines Long-Term Follow-Up Guidelines for Childhood, Adolescent, and Young Adult for Childhood, Adolescent, and Young Adult CancersCancers

• Encourage patients to be healthyEncourage patients to be healthy• Help patient to feel comfortable, so they are more Help patient to feel comfortable, so they are more

likely to come back for F/U visitslikely to come back for F/U visits• Monitor appropriately for possible risks of physical, Monitor appropriately for possible risks of physical,

emotional, or cognitive impairments based on their emotional, or cognitive impairments based on their previous cancer and treatmentsprevious cancer and treatments

ReferencesReferences

• http://www.stjude.org/ltfuhttp://www.stjude.org/ltfu

• http://http://www.survivorshipguidelines.orgwww.survivorshipguidelines.org