Surviving Cancer has fallout
Apr 09, 2008, THE CANADIAN PRESS
More children with cancer are surviving than in the past because of advances in treatment, but that doesn’t mean the battle is over for all of them, the Canadian Cancer Society says.
For all childhood cancers combined, 82 per cent of Canadian kids are living at least five years after diagnosis, a jump of 11 per cent in the last 15 years, the society said today in releasing its 2008 estimated national statistics on the disease.
About 850 Canadian children will be diagnosed with cancer this year and about 135 will die from the disease. (Overall, more than 166,000 Canadians of all ages will be diagnosed with cancer in 2008, and almost 74,000 will die.)
“We know that childhood cancer, fortunately, is a rare disease, but it is the leading cause of disease-related death in children over one month, second only to accidents,” Heather Logan, the society’s director of cancer control policy, told a news conference.
“When you look at childhood survival ... it shows us the advances we have been able to make,” said Logan, noting that from 1985 to 1988, 71 out of every 100 Canadian children with cancer survived five years. That number rose to 82 in every 100 kids diagnosed between 1999 and 2003.
“And that’s 11 more faces that are alive now that wouldn’t have survived the disease more than 15 years ago.”
But that doesn’t mean their battle with the ravages of cancer are necessarily over: two thirds of kids who undergo cancer treatment develop “late-effect” health problems, and about a third of those are serious or life-threatening.
Alberta pediatric oncologist Dr. Paul Grundy, chair of the C17 Research Network for childhood cancer, said kids who survive malignancies are at increased risk for physical and emotional health problems later in life.
Changes in the brain resulting from chemotherapy and radiation can alter the ability to think and reason, causing difficulties in school; effects on the hormones and metabolism can cause such problems as infertility and delayed puberty; and certain organs, among them the heart, lungs and stomach, can also be damaged.
“There are side-effects of treatment that may not even occur for up to 20 years after the therapy,” Grundy explained.
“We’re very concerned about the development of second cancers, so not a relapse or recurrence of their original disease, but the development of an entirely new cancer, probably in large part caused by the original cancer chemotherapy or radiation,” he said.
“These are the physical ones. We also have to be concerned about various psychological or emotional issues related to cancer survivorship.”
Trevor Johnson is all too familiar with cancer and the ongoing fallout from treatment. Now 23, he was diagnosed at four with leukemia and treated for three years with chemotherapy and radiation — including cranial radiation to prevent spread of the disease to his central nervous system — before the cancer was declared in remission.
But at age nine, the leukemia returned and he endured another three years of even more intensive treatment before he was again declared cancer-free.
“When I had the cranial radiation back when I was four, it did stunt my growth a bit, especially my upper extremity,” said Johnson, who works in sales for the Toronto Blue Jays baseball club and is celebrating 12 years without cancer.
There has also been some damage to his heart, for which he takes medication. “It’s nothing major, but we have to keep an eye on it.”
Grundy said for some childhood cancers, doctors have been able to secure remission with lower amounts of chemo and radiation — and that may reduce adverse effects later in life. But for other types, the maximal amount and intensity of treatment is still needed to achieve an acceptable cure rate.
Only time will tell how young patients will be affected, he said.
“We don’t know what the late effects or what possible late effects there may be 30, 40, 50 years after cancer chemotherapy because we don’t have a significant number of children who survived cancer from 30 and 40 years ago.”
“We are getting a better handle on the incidence of effects 10 to 20 years off therapy, but for the further future that’s still an open question.”
When it comes to overall cancer statistics among Canadians of all ages, the society’s Dr. Loraine Marrett said there has been remarkable progress over the last 10 to 15 years in preventing, diagnosing and treating many kinds of tumours.
But the disease still presents huge challenges: one Canadian is diagnosed with cancer every three minutes and one Canadian dies as a result of their malignancy every seven minutes, said Marrett, putting the statistics in stark day-to-day terms.
“Breast cancer continues to be the most common cancer in women with about 22,000 new diagnoses this year,” she said. “The good news for breast cancer is that the death rate has been steadily declining and is about 25 per cent lower than it was 20 years ago.”
While prostate cancer is the most common malignancy diagnosed in men (almost 25,000 cases), death rates have been declining over the past decade, she said.
“So lung cancer continues to be the Number 1 cause of cancer death in both men and women (20,000 in all) and colorectal cancer is the second leading cause of cancer death, with about 9,000 in both sexes combined,” Marrett said.
Lung cancer in females continues to be of huge concern because incidence and death rates are persistently on the rise, and experts know it will be some time before reduced smoking patterns among women are favourably reflected in the statistics.
In fact, if lung cancer were removed from the equation, women’s overall cancer death rate would be 20 per cent lower today than it was 25 years ago, said Marrett, “a dramatic indication of the impact of this cancer.”
“So we’ve made some progress, but there still remains a lot to be done.”
Childhood cancer in Canada
- In 2008, an estimated 850 children will be diagnosed with cancer and 135 will die from the disease.
- 82 per cent will survive at least five years.
- Leukemia is the most common cancer, accounting for a third of new cases and 27 per cent of deaths.
- Cancers of the central nervous system are the second most common (20 per cent of new cases, 30 per cent of deaths), followed by lymphomas (12 per cent of new cases, five per cent of deaths).
- Overall, cancer occurs more commonly in boys than girls.
- Since 1985, overall incidence has remained relatively stable, varying from 144 per million children to 159 per million.
- Since 1985, the death rate has been slashed, to 20 per million children from 40 per million.
Source: Canadian Cancer Society
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