The Long-Term Impact of Childhood Cancer Treatments
Maya Oldroyd was just three years old when she was diagnosed with stage 4 neuroblastoma, a rare and aggressive cancer that had developed in her nerve tissue. After eighteen months of multiple surgeries and intense treatments, Maya was declared cancer-free. However, the very therapies that saved her life also left her with complex, lifelong health issues.
“I’ve had hearing loss, I’ve had chronic illness, stuff that you wouldn’t think would happen [due to cancer treatment] but it does,” Maya shared. At ten, specialists told her she was in early menopause and would be infertile. By thirteen, she had part of her small bowel removed. Now sixteen, Maya continues to manage hearing loss and a chronic gut condition, supported by her family.
Maya’s story is not unique. Four out of five survivors of childhood cancer experience at least one long-term health problem, including pain, fatigue, infertility, and memory decline. As more Australian children beat childhood cancer, researchers are uncovering the potential long-term impacts of cancer treatments.
More than 20 Australian health and research organisations, led by the non-profit organisation Children’s Cancer CoLab, are advocating for greater awareness, effort, and investment in the care of the youngest cancer survivors. They argue that the focus must shift from simply keeping kids alive to ensuring they have a good quality of life.
Paediatric Cancer in Australia
In Australia, approximately 750 children aged 14 years and younger are diagnosed with cancer each year. Greg Wheeler, a radiation oncologist at the Peter MacCallum Cancer Centre, notes that survival rates for kids with cancer have improved significantly over the past few decades. Dr. Wheeler also runs the hospital’s paediatric and late effects unit, which monitors and treats patients who have survived childhood cancer.
“Overall, the prognosis of childhood cancers is significantly better than adult cancers,” Dr. Wheeler said. “We expect about 80 per cent of kids diagnosed with childhood cancer to survive.”
He explained that the main treatments for both adults and children include chemotherapy, radiation, and surgery. While these treatments are similar, Dr. Wheeler pointed out that children often cope better with more intensive chemotherapy than adults. However, there is a delay in making new cancer drugs available for children, as chemotherapy agents approved for adults require further testing before they can be safely used in children.
Chronic Health Issues for Survivors
When someone has cancer, their cells grow uncontrollably and lose function, which can be deadly if they spread and disrupt organ function. Chemotherapy and radiation target fast-growing cancer cells, but they can also accidentally destroy other non-cancerous cells, such as blood or hair cells, causing side effects like hair loss and fatigue.
After treatment ends, healthy cells start to regrow, and temporary side effects usually disappear. However, these treatments can have long-term side effects, according to Maria McCarthy, who leads the psycho-oncology and cancer survivorship research program at Murdoch Children’s Research Institute.
“When children have cancer, obviously the treatment they are receiving is during times of critical development,” Dr. McCarthy said. “Their bodies are developing, their brains are developing, and [cancer treatments] can have a significant impact on their long-term health.”
Dr. Wheeler urged childhood cancer survivors not to panic about future health conditions but emphasized the importance of being aware of their individual risk profile. “Not everyone carries the same risk,” he said. “Not everyone needs an intensive survivorship plan, but everyone needs to be aware they may need it.”
‘Invisible Impacts’ for Families
Udani Reets, head of Children’s Cancer CoLab, highlighted the need for comprehensive lifelong care for survivors, even after they are declared cancer-free. She also noted the “invisible impacts” associated with childhood cancer, such as medical trauma, financial distress, social isolation, and mental health challenges.
Tracy Hollington, whose son Angus was diagnosed with cancer twice, described the experience as a “complete tornado” that disrupted her family. Angus was diagnosed with Ewing sarcoma, an aggressive bone tumour, in 2014 when he was 11. Five years later, due to treatment from the first round of cancer, he developed secondary acute myeloid leukaemia. His leg was eventually amputated, and after 18 rounds of chemotherapy and a stem cell donation, he is now cancer-free but faces complex health conditions, including infertility and cardiomyopathy.
Angus believes that alongside better and less toxic treatments for children, there should be support to help survivors navigate adult hospitals and return to school and work. He also thinks people with lived experience of cancer should be consulted about the delivery of health services, as well as future research and funding priorities.
Where to from Here?
Maya, who underwent chemotherapy, radiation, and immunotherapy, will start having breast screenings in her 20s—decades ahead of her peers—to prevent secondary breast cancer. For now, her focus is on her bright future, with ambitions of performing on stage after finishing school next year.
“I don’t know what the future is going to hold, it’s really unpredictable,” she said. “I don’t know if my gut is going to flair up again, if I relapse, if my hearing is going to get worse.”
As for Angus, his goals are clear. “Retain my remaining limbs. No more cancer,” he said. “I look forward to where my career will take me, and hopefully soon being able to save enough to buy a small place of my own.”
