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1. admin says:

   September 2 at 11:38 am

   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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