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Surviving pediatric cancer

A closer look at how childhood cancer impacts survivors as they age


Gerardo Paz is mature beyond his 20 years of age.

A resident of Waxhaw, North Carolina, Paz has been working inventory since February, saving money in order to go to college. He wants to be a nurse. “Nurses help out people even in the smallest ways,” Paz said. “They are so kind.”

Paz knows the impact nurses have firsthand. As a pediatric cancer survivor, he spent several years undergoing treatment administered by nurses at Novant Health Hemby Children’s Hospital and felt the care and compassion directly. “I want to give back to others,” Paz said.

At age 15, Paz began feeling unwell. He was tired, had no energy and was very pale. His mother took Paz to the hospital for evaluation and after some blood work, he learned he had leukemia.

Paz underwent three years of chemotherapy. And while he said he is grateful to have survived cancer, he has some regrets.

“I missed out on things when I was sick and I feel it holds me back sometimes,” Paz said. “I didn’t really experience the first two years of high school, playing sports and making friends. Once I was better, I had to get used to being with regular people because I had spent so much time alone reading books.”

Paz is not alone in bearing some scars from his cancer treatment. According to the National Institutes of Health, an estimated 14.5 million Americans are cancer survivors and nearly 400,000 of these survivors were first diagnosed when they were children. Because of advances in cancer treatment, more than 80 percent of children diagnosed with cancer are alive five years after the first diagnosis. Many of them ultimately survive, but there is a chance that these children will have long-term health problems as they age.

“Research has shown that pediatric cancer survivors have a high risk of metabolic syndrome,” said Dr. Christine Bolen, a pediatric oncologist with the St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital. “The metabolic syndrome includes insulin resistance, abnormal cholesterol levels and elevated blood pressure which put survivors at risk for the development of diabetes and early-onset cardiovascular events including stroke.”

According to the National Cancer Institute, late effects are health problems in children that occur months or years after treatment has ended and can be caused by surgery, chemotherapy and radiation.

“Any radiation to the central nervous system is a risk factor for metabolic syndrome, so patients with brain or spinal tumors might be at increased risk,” Bolen said.

“Leukemia is a very common pediatric cancer and in treatment patients are exposed to steroids, which can lead to obesity and metabolic syndrome as well,” she added.

Bolen said that part of the follow-up for pediatric cancer survivors is ensuring they are following a healthy diet, engaging in regular physical exercise and maintaining an ideal weight. “By treating high blood pressure aggressively early on, a child may do better at age 40,” she said.

These health problems can affect not only organs and tissue, but moods, feelings, psychological adjustment as well as growth and development.

“The emotional consequences of childhood cancer treatments are significant,” Bolen said. “Children are pulled out of normal routines. Often they don’t develop the normal relationships with peers, and re-establishing those relationships after treatment may be difficult because the friends are in different places in life.”

In many ways, young cancer survivors like Paz are far more mature than their peers.

Factors that impact the risk of developing health problems later in life include the type of cancer and where the tumor was located, as well as how it was treated and other issues such as a child’s gender and age at time of treatment.

Childhood cancer survivors are living longer but can have late effects from cancer treatment. This is why it is imperative that childhood cancer survivors have regular follow-up appointments.

At the St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital, the care team hosts a monthly clinic for survivors called HOPES, which stands for Helping Oncology Patients Embrace Survivorship. It’s a comprehensive, proactive way for patients to visit with a team of physicians, nurses, social workers and nutritionists to address current and potential health concerns.

“These children have endured incredible challenges and experienced many life changes,” Bolen said. “Survivors want to encourage other children with cancer and impact their lives in positive ways. They want to give back.”

Of Paz, she said: “He’ll be an incredible nurse."





Published: 9/15/2015