As promised, I will discuss a few of the most common late effects after the treatments are completed. The common ones come from some of the same chemotherapy agents used in a variety of illnesses such as Adriamycin, Vincristine, and intrathecal Methatrexate. The intrathecal means it is delivered directly to the CNS or central nervous system via a spinal tap. These three drugs have proven to be powerful weapons in the fight against cancer cells. They have allowed individuals to reach remission both long and short term. The key of course is the long term remission or cure. Attaining a state of health with minimal disadvantages is still a bit of an unknown. The doctors know how to get to remission but because of the unwanted results of late effects they continue to tweak with trials on current patients and record from past patients. Let’s get started.
Adriamycin – This behemoth of a drug is used in most of the diagnoses at some stage of treatment. It may be tried during the first round or after a relapse. The problem is the affect it has on the heart. It damages the muscles and valves, which in turn causes changes to the pumping ability. Anyone that has received this chemotherapy agent must have a Muga Scan regularly. Depending on the dose given, the timeframe may be annually or some variation of this. Joey’s was annually because of the high dose he received as well as the number of times it was given. The Muga Scan registers and measures the ejection rate of the heart’s function. We love any high number, but definitely above 60%. This means the valves and muscle are working properly. The down side is the chest pains, physical weakness, and decreased stamina. In addition, there may be a need for heart medication. Unfortunately, for Joey, he experienced all these symptoms. He also began taking blood pressure medication in hopes of mitigated these late effects. Sadly, he did not experience the relief we hoped for.
Vincristine – This is another powerhouse drug that works wonders for killing cancer cells and helping patients reach remission. The late effects are seen with dexterity and balance. These are also experienced during treatment that results in the dose being lowered. The goal is that the decrease will not diminish its ability to rid the body of cancer. The dexterity issues that remain include ability to hold pens and pencils or similar objects. It also showed up in the handwriting being sloppy or illegible. The balance concerns manifested with walking or running. It can be clumsy and awkward at times. Joey would make adjustments in silence as I am sure everyone with this problem does. One of these included staying away from sports.
Intrathecal Methotrexate – This is a drug that can be taken by mouth as well. However, the intrathecal process allows it to pass over the natural defense of the brain barrier. Those nasty cancer cells love to hide here. Unfortunately, the consequences are more serious with learning disabilities being the start. Joey had his share of impaired cognitive reasoning and spatial deficits. For children under the age of two that receive this therapy, the chances increase for these types of problems. Joey was two and a half when he got his first dose. In addition, he received quite a bit of this during his five years of treatment. It becomes crucial to equip them with work arounds, strategies, and tactics to minimize any late effects. Since they are seen during treatment, this process starts at the beginning. This translated to no rushing and yelling. Calmness and peace make a big impact. Chaos only exacerbates the issue. When school starts there is a need for medical exceptions for taking tests or having someone take notes for you. Vincristine heightens this process as well with dexterity problems.
Let me stress that all children that survive don’t face these or if they do, it is minimal. The issue is that they experience any amount of late effects. Caregivers and medical professionals have developed an infrastructure of support through information. We share it with each doctor visit or patient survey. We reach out to each other as we forge along with these strong and brave children a way through late effects. Encourage your child to talk about any problems they experience as a way for them to know they are not alone nor have to deal with this in silence. The treatment modifications continue to combat the problems associated with late effects with information gleaned from children that survive. It is a daunting task that we will champion until there are no late effects experienced by any child. Remain vigilant and informed about this issue. Never ignore or minimize it. Instead fight it with all the weapons available.
My next post will discuss the support system and its importance to the childhood cancer survivor. As always, thanks for stopping by. My goal is that this will empower anyone that reads it.
Many blessings!
-Marsha