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Clinic Plays Important Role in Maintaining Health of Childhood Cancer Survivors

CCH Newsletter - Summer 2011

By Lindsey Garner

Megan Evans, an 18-year-old senior at St. Pius X High School in Houston, lives her life at full speed.

When talking about her daughter’s hobbies, her mother, Maureen, says with a quip, “Are you kidding me? I can’t keep up with this kid!”

She’s a member of the varsity cheerleading team, swim team, student cabinet, National Honor Society and science club, as well as co-editor of her school’s yearbook — all while preparing for graduation.

As a survivor of Ewing’s sarcoma, a rare bone cancer, Evans takes steps to make sure that she can continue to lead an active life for many years to come.  She maintains a healthy lifestyle and visits the Childhood Cancer Survivor Clinic at MD Anderson’s Children’s Cancer Hospital for long-term follow-up care.

Benchmark guidelines for care

Improved treatment and therapies, like those available at the MD Anderson Children’s Cancer Hospital, have increased the survival rate of children with cancer. However, these treatments and therapies can put childhood cancer survivors at risk of developing late effects — health problems that appear months or years after treatment.

The most common late effects in childhood cancer survivors involve growth, the heart, fertility, the thyroid, second cancers and cognitive development. To address late effects, the Children’s Oncology Group (COG) developed national guidelines – Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers, which are used at the Childhood Cancer Survivor Clinic.

Organized by cancer treatments, the COG guidelines use the therapeutic agents, which determine the potential late effects and risk factors survivors face. Each section also includes screenings and health counseling topics that address the late effects and risks of each treatment.

During her regular visit to the Childhood Cancer Survivor Clinic when Evans was 12, an abnormal chest X-ray led to additional scans and tests to rule out a recurrence of her cancer. Clear tests and a positive follow-up visit put Evans’ and her mother’s fears to rest.

Evans’ monitors for late effects by visiting the clinic annually for lab work and chest X-rays to monitor for metastases. This screening is important because the lungs are one of the most common sites for secondary tumors in Ewing’s sarcoma survivors.

Prior to the COG guidelines being published in 2003, late effects monitoring was largely based on the experience of each physician and his or her knowledge of published literature.

For the more than 250,000 childhood cancer survivors in the United States, these guidelines help to standardize and enhance follow-up care, as well as increase awareness of potential late effects.

Ahead of the curve

Most childhood cancer survivors eventually return to their primary care physicians for routine care after completing treatment. Developing an individualized, long-term, follow-up plan to monitor for late effects is extremely beneficial to primary care physicians who might not be as familiar with possible problems as oncologists. Additionally, MD Anderson recommends yearly long-term, follow-up in the Childhood Cancer Survivor Clinic or other clinic familiar with the late effects of cancer.

Joann Ater, M.D., and Megan 

“I would say that we’re ahead of the curve when it comes to survivorship,” says Joann Ater, M.D., professor in the Department of Pediatrics Patient Care. “The Children’s Cancer Hospital has a long history of providing a clinic for survivors — more than 30 years.”

In addition to monitoring for late effects, the Childhood Cancer Survivor Clinic is also a “good coordinating clinic to help survivors gain access to all the services they need within the institution,” Ater says.

Evans benefitted from the clinic’s coordinated efforts when she wanted to lifeguard at a local pool over summer breaks from school. Due to her skin’s sensitivity to the sun, the clinic referred her to an MD Anderson dermatologist. With regular clear skin checks, she has been a lifeguard for the past three summers.

Support to move forward

In addition to the nutritional, clinical and psychological support services provided, the Childhood Cancer Survivor Clinic also offers survivors educational and vocational support.

“Each time we visit the clinic, Megan is always asked about what her aspirations are for the future,” Maureen says.

Inspired by her oncologist Cynthia Herzog, M.D., professor in the Department of Pediatrics, Evans wants to pursue a career in pediatric oncology.

“I really love kids and making a difference in their lives,” Evans says. “With pediatric oncology, I can relate to them and have that connection.”

To help Evans achieve her goal, the Childhood Cancer Survivor Clinic provided her with information on scholarships available to childhood cancer survivors through the Children’s Art Project and Children’s Cancer Hospital. She is applying for several scholarships that would help her while studying biomedical sciences at Texas A&M University beginning this fall.

Celebrate and educate

In honor of National Cancer Survivors Day, the Children’s Cancer Hospital will host a celebration on Sept. 10 at the John P. McGovern Museum of Health & Medical Science. The festivities will include museum tours, health information and refreshments. An art installation created by Children’s Cancer Hospital patients and designed by artist-in-residence Ian Cion will also be unveiled.

© 2015 The University of Texas MD Anderson Cancer Center