Growing Pains:
Childhood cancer survivors cope with long-term effects of treatment

Jarred Duncan and Laura Selecki don't remember much about what it was like to have cancer. Duncan was diagnosed when he was 10 months old with a Wilms tumor; Selecki was a little older than 2 when doctors told her family she had rhabdomyosarcoma. Now the University of Michigan Comprehensive Cancer Center is helping them learn about what they don't remember-and how it will affect them as they grow older.

Sixteen years after her cancer diagnosis, Laura Selecki practices ballet in hopes of gaining a spot in Grand Valley State University's dance program.

Visit our Pediatric Long-term Follow-Up Clinic to learn more.

Duncan, now 10, has only one kidney, so he's extra careful when he plays sports. It doesn't stop him from bragging about having had the most stitches of anyone in his class, though. He and his mom, Josie, pay close attention to how much protein he eats. And he wonders if the chemo has something to do with why his teeth are so yellow and full of cavities.

Selecki doesn't think too much about having had cancer, but she knows she has to take extra good care of herself. She spends hours each week in ballet classes so she can win a spot in Grand Valley State University's dance program. She understands that she won't be able to have children as a result of cancer treatment, but it doesn't bother her-yet.

"Maybe later it will," said Selecki, 18, of Manchester, Mich. "But I know there are other options."

As the University of Michigan Comprehensive Cancer Center's Pediatric Long-term Follow-Up Clinic celebrates its 10th anniversary this year, its work has become a model for survivorship care. The clinic evolved out of need and a commitment: Patients should fully understand their risks and how best to address them. Researchers are beginning to take lessons learned from early successes in treating pediatric cancer survivors and apply it to adult populations.

By following childhood survivors closely as part of a national consortium of pediatric cancer research institutions, doctors have learned how to fine tune treatment to prevent many types of unanticipated long-term effects. For example, radiation to the chest, neck and armpit lymph nodes was at one time routinely used for all patients with Hodgkin's disease, said Marcia Leonard, R.N., P.N.P., director of Childhood Cancer Survivorship at the U-M Cancer Center. But long-term follow-up showed that girls who received radiation to the chest were 35 times more likely to develop breast cancer. Treatment protocols have been changed as a result.

"We've learned a lot from following our patients for many years," Leonard said. "Part of my job is to remind our physicians not just to focus on this minute, but to try to picture the rest of a child's life. We need to inform our patients now of what will happen in the future so they're not shocked.

"Ten years ago when we first started seeing patients in the Long-term Follow-up Clinic, we saw too many 18-year-olds who were shocked to learn of the possibility of infertility because no one had told them that their treatment was likely to cause such problems. Even when we can't do anything to prevent these effects, we at least need to educate our patients about them."

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