Long-term death rate among childhood cancer survivors falls by half

Progress against childhood cancer has been bittersweet.

Up to 80% of U.S. children now survive cancer -- more than at any time in history. But the chemotherapy and radiation that kill cancer cells can cause serious or even life-threatening side effects -- from second cancers to heart and lung problems -- as children grow up.

Now, a new study finds that doctors' efforts to both cure children's tumors and protect them from long-term complications have paid off. A study presented today in Chicago finds that the death rate 15 years after a pediatric cancer diagnosis has been cut in half since the 1970s.

About 6% of children treated for cancer from 1990 to 1994 died within 15 years of diagnosis, down from 12.4% of those treated from 1970 to 1974, according to a study of more than 34,000 patients presented at the annual meeting of the American Society of Clinical Oncology.

Everyone included in the study was considered to have survived their original cancer, because they lived at least five years after diagnosis. But the legacy of cancer continued to weigh heavily on patients, with about 41% of the nearly 4,000 deaths during the study related to the "late effects" of children's treatment, said Gregory Armstrong, principal researcher of the Childhood Cancer Survivor Study.

Yet death rates from all causes fell during the three decades of the study. Fewer people died because their original cancers came back; because they developed treatment-related cancers; or because of heart and lung problems.

"We've always struggled with the fact that therapy that beats the first cancer is causing problems down the road," said Armstrong, of St. Jude Children's Research Hospital. "It's the cost of cure."

Doctors have saved lives in several ways.

First, as doctors were able to cure more children, they looked for way to make treatment less toxic, but equally effective, said Lisa Diller, chief medical officer at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Clinical trials proved that it is sometimes safe to reduce the amount of radiation, to radiate a smaller portion of the body or, for some kids, skip radiation entirely.

Until recently, for example, doctors typically recommended that children with aggressive, high-risk leukemias undergo not just chemotherapy, but radiation to the brain. That radiation helped prevent relapses that could be fatal. But radiating the brain -- especially when children are very young -- can cause learning and memory problems.

Today, studies show that many children with high-risk leukemias can avoid brain radiation, said Jill Ginsberg, a pediatric oncologist and director of the cancer survivorship program at the Children's Hospital of Philadelphia's Cancer Center.

Not all children can avoid aggressive cancer therapies, Ginsberg said. Children with brain tumors still need harsh therapy, because their cancers are so hard to cure.

Beyond making treatment gentler, doctors today are saving lives by taking better care of survivors once they finish treatment, said Diller, who wasn't part of the new study. Many children's hospitals now offer survivor clinics, in which cancer specialists monitor patients for years after treatment ends.

Amy Greenfeig, was treated for Hodgkin's lymphoma when she was 11.

At 32, she was diagnosed with thyroid cancer, most likely as a result of chest radiation that helped cure her cancer. But thanks to frequent screenings, the tumor was detected and treated early. She's healthy today and the mother of a 6-year-old girl.

"I'm doing great," said Greenfeig, of Voorhees, N.J. "I have no real long-term effects."

Doctors now recommend that women such as Greenfeig begin breast cancer screening by age 25 -- about 15 years earlier than usual. So even if cancer survivors develop breast cancer, they're less likely to die from it, Diller said.

When Kate Franklin was diagnosed with leukemia at age 3, doctors warned her parents that many children treated with chemotherapy end up with learning disabilities. But Franklin, now 18, just finished high school, graduating third in her class. She will attend the University of Southern California next fall, studying biology and Spanish, with plans to become a doctor.

Last summer, Franklin interned in the lab of the Boston cancer researcher who treated her. She describes herself as fit and strong, able to compete in sports.

"My body holds up under anything I want to do," Franklin said.