Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood. Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families. Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship. His goal is simple: to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.
THE HEADLINE: Pregnancy Complications More Common in Cancer Survivors
THE RESEARCH: Journal of the National Cancer Institute: Pregnancy and Labor Complications in Female Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study. Researchers in the United Kingdom compiled data on pregnancy complications including gestational diabetes, high blood pressure, and anemia in 17,980 female childhood cancer survivors included in the British Childhood Cancer Survivor Study (BCCSS). From this cohort, 2,783 pregnancies in 1,712 childhood cancer survivors were identified. JAMA Oncology: Birth Outcomes Among Adolescent and Young Adult Cancer Survivors. Researchers in North Carolina used the North Carolina Central Cancer Registry (CCR) to identify 2,598 live births in adolescent and young adult (AYA) survivors of cancer. Birth outcomes including rate of preterm birth, low birth weight, small-for-gestational-age births, cesarean delivery, and low Apgar score were collected from these 2,598 births and compared to 12,990 control births matched for maternal age and year of delivery.
KEY FINDINGS: In the British study a comparison was made between survivors who received abdominal radiation and those who did not. In this comparison, survivors of Wilms tumor treated with abdominal radiation had a 3-fold increased risk of developing high blood pressure during pregnancy. Moreover, all survivors treated with abdominal radiation had an elevated risk of developing gestational diabetes and anemia, when compared to survivors that did not receive abdominal radiation. Survivors treated without radiation had similar rates of pregnancy and labor complications compared with the general population, except for an increased likelihood of opting for elective cesarean delivery. In the study using the North Carolina CCR, live births to AYA cancer survivors had significantly increased prevalence of preterm birth, low birth weight, and cesarean delivery when compared to the control cohort. The increased prevalence was most evident in those women receiving chemotherapy during pregnancy and those women with a diagnosis of breast cancer, non-Hodgkin lymphoma, or gynecologic cancers. The prevalence of low Apgar score (<7) and small-for-gestational age births did not differ significantly between births in the AYA cancer survivor and control groups.
WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS: With the rates of long-term survivorship continuing to increase, more women than ever are surviving cancer and going on to become pregnant and have children. Therefore, the need to quantify pregnancy complications and birth outcomes in female childhood cancer survivors has become exceedingly important. Of equal importance is working to ensure these risks are known both by patients and by the obstetricians that are tasked with caring for these survivors and their babies. The first study above highlights several increased risks for pregnancy complications in women who have previously received abdominal radiation. Likewise, the second study above illustrates the risks for babies of survivors, as infants born to these women are at increased risk for prematurity and low birth weight. Survivors should talk with their obstetricians about their previous treatments and the associated risks with respect to their pregnancy and their baby. When available, oncologists with knowledge of survivorship and outcomes should be included in the perinatal care plan.
Medical Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.
Videos with Dr. Aune
Presentation on YouTube (Jan 2015): Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD
Interview for the National Coalition for Cancer Survivorship (June 2015): Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care
Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends
Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar. His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy. His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma. While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens. His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies. This life-changing event initiated his research interest in cardiac disease. His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.
Dr. Aune is a national leader in childhood cancer advocacy efforts. In San Antonio, he has been a leader in local fundraising and awareness efforts. Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts. In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.
In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.
In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.