This saddens me too. In treating some kids, they are cured, but, but they have long-lasting learning difficulties. Forutantely, not all children who survive cancer end up with these difficulties (about 70% don’t). And I am glad that doctors are paying attention to these important aspects of children’s lives.
> January 8, 2003 > Young Survivors of Cancer Battle Effects of Treatment > By MARY DUENWALD and DENISE GRADY
> HILADELPHIA – Handing a deck of cards to Sarah Ludwig, the > psychologist said, "I want you to put the cards in order by suit, but > keep in a separate pile those cards with the letter T in their names."
> Sarah, 15, planned her strategy and, as the psychologist clicked a > stopwatch, began sorting.
> Ten years ago here at Children’s Hospital of Philadelphia, Sarah was > treated for leukemia, receiving an intensive two-year course of > chemotherapy and steroids.
> Today, she is free of the disease, but, possibly as a result of the > treatment, she has an impaired attention span and other learning > disabilities. Her work with the psychologist is part of a 20-week > experimental program intended to help improve her concentration and > performance in school.
> Many other patients who, like Sarah, were treated for cancer at a very > young age have found that the cure may come at a price: chemotherapy > and radiation given early in life can have effects on both body and > mind.
> Often, the physical problems are treatable. Now, doctors and > psychologists are also starting to address the learning difficulties, > as increasing numbers of young cancer survivors worry about school > grades, college admissions and career prospects – concerns about a > future that would have seemed an unimaginable luxury a generation ago.
> "Survival from childhood leukemia – the most common malignancy of > childhood – is something of a medical marvel that I think the average > person doesn’t appreciate," said Dr. Robert Butler, a psychologist at > Oregon Health and Science University who created the program in which > Sarah is enrolled. "In the 1960′s and early ’70′s, cancer was a death > sentence. There was a 90 percent probability that the child was going > to die. Now, there’s about an 80 percent chance that the child will be > cured. It’s turned around practically 180 degrees," Dr. Butler said.
> Survivors of childhood cancer number about 250,000 in the United > States, and their ranks are growing steadily because of aggressive and > effective treatments. Doctors are able to cure most cancers diagnosed > in children and teenagers, 11,000 to 12,000 cases a year, Dr. Butler > said.
> Over all, cure rates in adults are considerably lower, with only 62 > percent living 5 years or more. Dr. Paul A. Meyers, vice chairman of > pediatrics at Memorial Sloan Kettering Cancer Center in Manhattan, > cited several reasons why children with cancer fared better than > adults.
> For one, he said, since the 1950′s, 85 percent of children with cancer > – as opposed to only 2 percent of adults – have been treated in > clinical trials, which have been proved to offer the best care.
> In addition, Dr. Meyers said, the types of cancer that affect children > tend to be more treatable than those in adults, and children are > better able than adults to tolerate intensive treatment.
> But the treatments can have lingering side effects. Doctors have known > for about 20 years that chemotherapy and radiation administered early > in life can cause health problems, post-traumatic stress and learning > disabilities.
> Dr. Charles A. Sklar, director of a program for childhood cancer > survivors at Memorial Sloan Kettering, said that the physical ailments > confronting the young survivors might include stunted growth, low > thyroid function, kidney problems, infertility, heart and lung > disorders and even new cancers.
> Most of those illnesses can be treated, he said. But treatments for > the learning disorders remain experimental.
> The likelihood that a childhood cancer survivor will develop such > disorders depends on the child’s age at the time of treatment and the > intensity of the treatment, according to Dr. Pim Brouwers, a pediatric > neuropsychologist at Texas Children’s Cancer Center in Houston.
> Patients younger than 5 seem most vulnerable. Dr. Butler said: "We > used to think they would be the most likely to recover, because their > brains have greater plasticity. But the youngest children actually > take a bigger hit from the treatments."
> Children who have brain tumors – the second most prevalent form of > childhood cancer, after leukemia – are at greater risk than those with > other cancers. The tumor can damage brain tissue, Dr. Brouwers said, > and the treatment, typically radiation directed at the head and spinal > cord, can damage neurons.
> Doctors can minimize the damage by using only the lowest possible > doses of radiation, said Dr. Anna T. Meadows, a pediatric oncologist > at Children’s Hospital of Philadelphia.
> Dr. Butler estimated that as many as 90 percent of children who had > received radiation to the brain and spinal cord had some degree of > impairment. Young patients like Sarah with acute lymphoblastic > leukemia are often treated with chemotherapy alone. The drugs are > often injected into the space containing the brain and spinal cord. > Many of these children do not develop any cognitive problems, Dr. > Meadows said. And those who do, studies show, are likely to be less > impaired.
> About 30 percent of children who have received this chemotherapy end > up with learning or concentration problems, Dr. Butler said. Such > problems are also found among an undetermined number of children who > have not had cancer, he noted.
> Sarah’s problems were relatively mild compared with those of children > who received radiation. And though experts cannot say for certain that > chemotherapy caused her problems, Sarah’s experience follows the > pattern of other patients in her age group, according to Dr. Anne E. > Kazak, the director of psychology at Children’s Hospital of > Philadelphia and a researcher in Dr. Butler’s study.
> Radiation and chemotherapy can damage the cells of the basal ganglia, > a section of the brain involved in attention functions, Dr. Brouwers > said. The problems often do not show up until three years after the > children have finished treatments, studies show, because the brain > cells die off slowly.
> "It’s tough on the kids and tough on parents," Dr. Brouwers said. > "They’re told the disease is gone, and then after five years, the kid > is failing in school. And it just seems like it’s never over."
> The trauma of cancer itself can contribute to the problem, many > doctors and parents believe.
> "Sarah repeated kindergarten because she missed a lot of school for > her treatments," Sarah’s mother, Mary Ludwig, said. "It’s always > seemed as if she just never caught up."
> Throughout elementary school and middle school, Sarah had noticeable > difficulty paying attention and comprehending concepts that other > children picked up easily, Mrs. Ludwig said: "There was just always > something that she couldn’t grasp."
> Dr. Butler’s program, which consists of 20 two-hour sessions, tries to > teach techniques for focusing and organizing thoughts – skills other > children use without realizing it. The teaching methods are borrowed > from programs created to help people recover from strokes and other > brain injuries.
> At the session that Sarah sorted the cards, the psychologist, Dr. > Merritt M. Jensen, asked her, "How can you help yourself concentrate > on this?"
> "I could make a key," Sarah suggested, consulting the list of > strategies that she and Dr. Jensen began compiling in their first five > sessions. Sarah picked up her pencil and wrote the list of "T" cards > on a nearby pad: 2′s, 3′s, 8′s and 10′s.
> Dr. Jensen started a stopwatch as Sarah began sorting. In less than > two minutes, she was finished.
> "I could do a better job than that," Sarah said, her shoulders > dropping."I was trying to go too fast."
> Dr. Jensen examined the piles. "You caught 12 of the T cards and only > missed 4," she said. "To me, that’s good work."
> By playing the card game, Sarah was practicing simple concentration > techniques and learning to think about strategies, like making written > keys and monitoring her own speed and attention.
> "If she can practice and talk about the skills she needs to develop, > I’m hoping they can become ingrained," Dr. Jensen said.
> Children in the program are instructed to work with pencil and paper > on number problems and word puzzles. They play games like Uno and > Mastermind that require concentration and memory skills. Homework is > also incorporated into the training.
> Dr. Butler and his colleagues at seven hospitals across the country > have been testing the program for almost three years. To be eligible > for the training, children must be at least a year beyond their cancer > treatment, and they must demonstrate problems in perception and > concentration.
> The researchers intend to use the techniques with more than 100 > children by midyear. These subjects will be compared with a somewhat > smaller group of cancer survivors who receive no training for six > months. The children in the control group are tested at the start and > the end of the six-month period, and then are also offered a chance to > take the training.
> At best, however, the problems that the young cancer survivors > experience with concentration and learning will diminish, not > disappear, Dr. Kazak said. And other learning problems are likely to > persist. A pilot study of the training Dr. Butler conducted in 1995
This saddens me too. In treating some kids, they are cured, but, but they
have long-lasting learning difficulties. Forutantely, not all children who
survive cancer end up with these difficulties (about 70% don’t). And I am
glad that doctors are paying attention to these important aspects of
children’s lives.
All the best,
Jeff
"Ilena" <il…@san.rr.com> wrote in message
news:19faaec.0301142035.6dcc690a@posting.google.com…
- Hide quoted text — Show quoted text -
> ————————————————————————–
——
> January 8, 2003
> Young Survivors of Cancer Battle Effects of Treatment
> By MARY DUENWALD and DENISE GRADY
> HILADELPHIA – Handing a deck of cards to Sarah Ludwig, the
> psychologist said, "I want you to put the cards in order by suit, but
> keep in a separate pile those cards with the letter T in their names."
> Sarah, 15, planned her strategy and, as the psychologist clicked a
> stopwatch, began sorting.
> Ten years ago here at Children’s Hospital of Philadelphia, Sarah was
> treated for leukemia, receiving an intensive two-year course of
> chemotherapy and steroids.
> Today, she is free of the disease, but, possibly as a result of the
> treatment, she has an impaired attention span and other learning
> disabilities. Her work with the psychologist is part of a 20-week
> experimental program intended to help improve her concentration and
> performance in school.
> Many other patients who, like Sarah, were treated for cancer at a very
> young age have found that the cure may come at a price: chemotherapy
> and radiation given early in life can have effects on both body and
> mind.
> Often, the physical problems are treatable. Now, doctors and
> psychologists are also starting to address the learning difficulties,
> as increasing numbers of young cancer survivors worry about school
> grades, college admissions and career prospects – concerns about a
> future that would have seemed an unimaginable luxury a generation ago.
> "Survival from childhood leukemia – the most common malignancy of
> childhood – is something of a medical marvel that I think the average
> person doesn’t appreciate," said Dr. Robert Butler, a psychologist at
> Oregon Health and Science University who created the program in which
> Sarah is enrolled. "In the 1960′s and early ’70′s, cancer was a death
> sentence. There was a 90 percent probability that the child was going
> to die. Now, there’s about an 80 percent chance that the child will be
> cured. It’s turned around practically 180 degrees," Dr. Butler said.
> Survivors of childhood cancer number about 250,000 in the United
> States, and their ranks are growing steadily because of aggressive and
> effective treatments. Doctors are able to cure most cancers diagnosed
> in children and teenagers, 11,000 to 12,000 cases a year, Dr. Butler
> said.
> Over all, cure rates in adults are considerably lower, with only 62
> percent living 5 years or more. Dr. Paul A. Meyers, vice chairman of
> pediatrics at Memorial Sloan Kettering Cancer Center in Manhattan,
> cited several reasons why children with cancer fared better than
> adults.
> For one, he said, since the 1950′s, 85 percent of children with cancer
> – as opposed to only 2 percent of adults – have been treated in
> clinical trials, which have been proved to offer the best care.
> In addition, Dr. Meyers said, the types of cancer that affect children
> tend to be more treatable than those in adults, and children are
> better able than adults to tolerate intensive treatment.
> But the treatments can have lingering side effects. Doctors have known
> for about 20 years that chemotherapy and radiation administered early
> in life can cause health problems, post-traumatic stress and learning
> disabilities.
> Dr. Charles A. Sklar, director of a program for childhood cancer
> survivors at Memorial Sloan Kettering, said that the physical ailments
> confronting the young survivors might include stunted growth, low
> thyroid function, kidney problems, infertility, heart and lung
> disorders and even new cancers.
> Most of those illnesses can be treated, he said. But treatments for
> the learning disorders remain experimental.
> The likelihood that a childhood cancer survivor will develop such
> disorders depends on the child’s age at the time of treatment and the
> intensity of the treatment, according to Dr. Pim Brouwers, a pediatric
> neuropsychologist at Texas Children’s Cancer Center in Houston.
> Patients younger than 5 seem most vulnerable. Dr. Butler said: "We
> used to think they would be the most likely to recover, because their
> brains have greater plasticity. But the youngest children actually
> take a bigger hit from the treatments."
> Children who have brain tumors – the second most prevalent form of
> childhood cancer, after leukemia – are at greater risk than those with
> other cancers. The tumor can damage brain tissue, Dr. Brouwers said,
> and the treatment, typically radiation directed at the head and spinal
> cord, can damage neurons.
> Doctors can minimize the damage by using only the lowest possible
> doses of radiation, said Dr. Anna T. Meadows, a pediatric oncologist
> at Children’s Hospital of Philadelphia.
> Dr. Butler estimated that as many as 90 percent of children who had
> received radiation to the brain and spinal cord had some degree of
> impairment. Young patients like Sarah with acute lymphoblastic
> leukemia are often treated with chemotherapy alone. The drugs are
> often injected into the space containing the brain and spinal cord.
> Many of these children do not develop any cognitive problems, Dr.
> Meadows said. And those who do, studies show, are likely to be less
> impaired.
> About 30 percent of children who have received this chemotherapy end
> up with learning or concentration problems, Dr. Butler said. Such
> problems are also found among an undetermined number of children who
> have not had cancer, he noted.
> Sarah’s problems were relatively mild compared with those of children
> who received radiation. And though experts cannot say for certain that
> chemotherapy caused her problems, Sarah’s experience follows the
> pattern of other patients in her age group, according to Dr. Anne E.
> Kazak, the director of psychology at Children’s Hospital of
> Philadelphia and a researcher in Dr. Butler’s study.
> Radiation and chemotherapy can damage the cells of the basal ganglia,
> a section of the brain involved in attention functions, Dr. Brouwers
> said. The problems often do not show up until three years after the
> children have finished treatments, studies show, because the brain
> cells die off slowly.
> "It’s tough on the kids and tough on parents," Dr. Brouwers said.
> "They’re told the disease is gone, and then after five years, the kid
> is failing in school. And it just seems like it’s never over."
> The trauma of cancer itself can contribute to the problem, many
> doctors and parents believe.
> "Sarah repeated kindergarten because she missed a lot of school for
> her treatments," Sarah’s mother, Mary Ludwig, said. "It’s always
> seemed as if she just never caught up."
> Throughout elementary school and middle school, Sarah had noticeable
> difficulty paying attention and comprehending concepts that other
> children picked up easily, Mrs. Ludwig said: "There was just always
> something that she couldn’t grasp."
> Dr. Butler’s program, which consists of 20 two-hour sessions, tries to
> teach techniques for focusing and organizing thoughts – skills other
> children use without realizing it. The teaching methods are borrowed
> from programs created to help people recover from strokes and other
> brain injuries.
> At the session that Sarah sorted the cards, the psychologist, Dr.
> Merritt M. Jensen, asked her, "How can you help yourself concentrate
> on this?"
> "I could make a key," Sarah suggested, consulting the list of
> strategies that she and Dr. Jensen began compiling in their first five
> sessions. Sarah picked up her pencil and wrote the list of "T" cards
> on a nearby pad: 2′s, 3′s, 8′s and 10′s.
> Dr. Jensen started a stopwatch as Sarah began sorting. In less than
> two minutes, she was finished.
> "I could do a better job than that," Sarah said, her shoulders
> dropping."I was trying to go too fast."
> Dr. Jensen examined the piles. "You caught 12 of the T cards and only
> missed 4," she said. "To me, that’s good work."
> By playing the card game, Sarah was practicing simple concentration
> techniques and learning to think about strategies, like making written
> keys and monitoring her own speed and attention.
> "If she can practice and talk about the skills she needs to develop,
> I’m hoping they can become ingrained," Dr. Jensen said.
> Children in the program are instructed to work with pencil and paper
> on number problems and word puzzles. They play games like Uno and
> Mastermind that require concentration and memory skills. Homework is
> also incorporated into the training.
> Dr. Butler and his colleagues at seven hospitals across the country
> have been testing the program for almost three years. To be eligible
> for the training, children must be at least a year beyond their cancer
> treatment, and they must demonstrate problems in perception and
> concentration.
> The researchers intend to use the techniques with more than 100
> children by midyear. These subjects will be compared with a somewhat
> smaller group of cancer survivors who receive no training for six
> months. The children in the control group are tested at the start and
> the end of the six-month period, and then are also offered a chance to
> take the training.
> At best, however, the problems that the young cancer survivors
> experience with concentration and learning will diminish, not
> disappear, Dr. Kazak said. And other learning problems are likely to
> persist. A pilot study of the training Dr. Butler conducted in 1995
…
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