Beating A Killer
Cancer was once the end of the line. Today, it can be managed and defeated
Nearly 10 million Americans, from the halls of the Supreme Court to the pueblos of New Mexico, are living with cancer. Most were diagnosed five or more years ago; many who would have died just 15 or 20 years ago are alive today, raising families, leading productive lives. Yet doctors are only now beginning to study these survivors and to understand how the very therapies that cured them can also create a whole new set of problems--some, many years later. Joe Fred Starr never seemed to have had a melancholy moment in his life until after his cancer treatments. A young man in his 20s might beat testicular cancer only to have heart problems in his 40s. A 65-year-old breast cancer survivor might experience confusion and memory problems. Not to mention the fatigue, pain, and sexual dysfunction that can haunt survivors of all ages.
In response to the burgeoning needs of cancer survivors, the federal Centers for Disease Control and Prevention and the Lance Armstrong Foundation will release in April a public-health blueprint for addressing the needs of cancer survivors. New York's Memorial Sloan-Kettering and Boston's Dana-Farber have both launched "survivorship" programs in the past six months. M. D. Anderson and the University of Pennsylvania have had such centers for a few years. The field is still in its infancy, but such programs are sensitizing more doctors to the demands of cancer survival.
One major source of later problems is radiation. In 1981, researchers at the University of Pennsylvania reported that kids with leukemia suffered significant drops in IQ when their treatment regimen included head irradiation, the standard of care at that time. Mark Kieran, director of pediatric neuro-oncology at Dana-Farber, remembers walking into a clinic in 1992 to see a 20-year-old follow- up patient who was "cured" of pediatric brain cancer 15 years before. He was rocking back and forth in a chair, sucking his thumb. "From a statistical point of view, he was a survivor," Kieran says. "But when we treated him, we just didn't know what the damaging effects of the therapy would be, because no one survived." As evidence mounted, however, doctors found it wasn't necessary to radiate the entire head. Today, happily, such patients have a much better prognosis.
Brain cancer accounts for approximately 17 percent of all cancers among those under age 20, which means there will be more than 2,000 new cases diagnosed this year. Between 1974 and 1976, about half of the children with brain cancer survived; between 1992 and 1998, nearly 70 percent did. A child's developing brain is highly vulnerable to the assault of radiation, because new neural connections are occurring so rapidly. Indeed, Lisa DeAngelis, head of neurology at Sloan-Kettering, says that today, even if radiation is deemed the best treatment for a child under 2, "we still don't do it, even if we are buying time." Researchers have found that the brain's white matter--the region most involved in higher cognitive function--takes the brunt of the damage from radiation. Radiation works by damaging a tumor's genetic material so it can't continue growing. It was once thought that healthy tissue surrounding the tumor would survive such a chemical assault, and in some parts of the body that's true. But it turns out that the delicate white matter of the brain is not so resilient.