Childhood cancer cures come with a cost

Life-saving treatments do lasting damage to health

January 03, 1999|By NEW YORK TIMES NEWS SERVICE

BAYTOWN, Texas -- The scrapbook that documents Camelia Cruz's days as a teen-age cancer patient is yellowing now, its photos and newspaper clippings fading with the passage of time.

On this sunny Monday morning, Cruz cracked it open, as she does every now and then, unleashing a flood of memories from what seems like a former life. Cruz, now 22, is a survivor of osteosarcoma, a highly malignant bone tumor.

The cancer was diagnosed when she was 13. At an age when most girls are worried about pimples and boyfriends, Cruz, the former Camelia Trevino, lost her left leg; doctors had no choice but to amputate above the knee.

Then she endured a year of sickening chemotherapy that has left her with damaged kidneys, and received blood transfusions that are probably responsible for infecting her with hepatitis C, a potentially lethal virus.

Cruz is part of a trend that experts describe as a miracle of modern medicine: the transformation of childhood cancer from killer to curable disease.

But thankful though the children and their families are, the growing legion of survivors are discovering that the miracle has not been without a price.

In the late 1960s, fewer than one-third of cancer patients under age 15 lived for five years past their date of diagnosis. Today, about three-quarters of all children being treated for cancer are expected to reach the five-year mark.

And as oncologists continue to refine their methods, the population of childhood cancer survivors, an estimated 250,000, is rapidly growing; the National Cancer Institute estimates that by 2000, one in 900 people between the ages of 16 and 44 will be a survivor of childhood cancer.

But as the first large wave of childhood cancer survivors reaches its 20s and 30s, the word "cured" is a misnomer for many.

Though some, particularly those treated more recently, glide through life virtually unscathed, others are finding that the two staples of cancer treatment, chemotherapy and radiation, can bring with them health problems: heart, lung and kidney dysfunction, memory loss, infertility and even second cancers.

It is estimated that about half of all children cured of cancer experience moderate to severe medical problems years later. Dr. Philip Steuber, the pediatric oncologist who treated Camelia Cruz, calls this "the cost of cure."

Because so few children survived cancer decades ago, doctors are only just beginning to comprehend how high those costs can be.

Experts know quite a bit about late effects in the first decade after treatment, but less about the second decade and very little after that. The issues are complicated; childhood cancer is really an array of more than a dozen different diseases, each with its course of treatment and side effects.

Much of today's research revolves around devising new treatments to minimize late effects, so that the children treated today may have fewer problems than their predecessors.

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