As a child, Lazaro Davis would sit in a white-walled hospital room playing 1080° Snowboarding on his Nintendo 64, and watch Disney Channel shows.
“I didn’t have the ability to do much,” said Davis, 21, who was diagnosed with acute lymphoblastic leukemia when he was 5.
The Miami Lakes resident is now in remission, thanks to treatments and a bone marrow transplant he received from his older brother Willie. Like other childhood cancer survivors, Davis must have his health monitored for late effects of treatment, or side effects that become apparent after your treatment has ended. His physician Dr. Enrique Escalon, director of the division of hematology/oncology at Nicklaus Children’s Hospital says late effects can occur over a few years, or over a few decades.
Risks of Late Effects
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The National Cancer Institute at the National Institutes of Health notes three key factors that can affect a child’s risk of developing late effects:
▪ Tumor-related factors: Tumor type, its location, and how it affects tissue and organ function.
▪ Treatment-related factors: Dose and frequency of chemotherapy, stem cell transplants, and surgery.
▪ Patient-related factors: Patient gender, genes and age at diagnosis.
Children who received radiation to their chest, abdomen or pelvic areas are at the highest risk, along with those treated for bone cancer, brain tumors or Hodgkin lymphoma. The National Cancer Institute reports that late effects can include second cancers, joint replacement, congestive heart failure and hearing loss.
Overall, survival rates for most childhood cancers have increased over the years. Acute lymphoblastic leukemia, the most common childhood cancer, has gone from a five-year survival rate of less than 10 percent in the 1960s to nearly 90 percent today, according to the National Cancer Institute.
“We are saving more patients, but we are seeing side effects we weren’t seeing before because the survival is extended,” Escalon said.
Not present until adulthood
Vicente Ramirez, 20, of Kendall was diagnosed with medulloblastoma, a type of brain tumor, when he was 13. After his first surgery, his left side was paralyzed. He had to relearn how to walk before undergoing radiation and chemotherapy.
“It’s so weird because you already know how to do such things, so when you have a walker and you can’t do it and you need the help — it’s weird,” Ramirez said.
Ramirez cannot run long distances like he used to, has some liver damage, and developed tinnitus (ear ringing) and hypothyroidism.
“I lost some coordination, but not strength,” Ramirez said.
Some late effects, such as infertility, may not be present in patients until adulthood, which is why doctors are addressing the issue early on.
“We are offering in teenage boys the option to do sperm banking,” said Dr. Doured Daghistani, medical director of pediatric oncology at Baptist Children’s Hospital.
Ramirez’s doctors took this option.
“It’s still very challenging for girls, to get to the ovaries and eggs — it’s still a ways from perfection,’’ Daghistani said. “I’m hoping in five to 10 years it will be so perfect we can offer it to teens and tell them you can have a child who looks like you.”
Cognitive issues can also develop from some treatments.
Dr. Julio C. Barredo, director of the children’s cancer programs at the University of Miami Sylvester Comprehensive Cancer Center, says younger patients are at higher risk as their brains are still developing.
“We try to avoid radiation in young patients because we know the consequences later,” Barredo said. “We try to minimize the long-term consequences as much as we can.”
Language and math skills often are most impacted, said Laurie Sargent, senior child life specialist at Baptist Children’s Hospital.
As a brain cancer patient, Ramirez went through speech therapy classes as his voice changed after surgery. At home he’d sing classic rock songs by Queen, The Beatles and AC/DC to help with his vocal skills.
“It worked,” said Ramirez. “All these things are so strange; it’s like you’re reinstalling these applications to your brain.”
To help with memory, Ramirez does brain exercises, naming countries, presidents and elements on the periodic table. He graduated with an associate’s degree from Miami Dade College and hopes to attend the University of Florida to study agriculture.
A healthy lifestyle
Dr. Deborah Kramer, a pediatric hematologist-oncologist at Joe DiMaggio Children’s Hospital in Broward, says some late effects, particularly related to cardiovascular issues and osteoporosis, may not be present when the patient is a child. As such, she educates her patients about living a healthy lifestyle.
“We do a lot of preventive care education on healthy diet and exercise,” she said. “You have to teach the child or young adult to become an advocate for their own health.”
One of Kramer’s patients, Abigail Qahhat, 13, went through chemotherapy and received steroids for acute lymphoblastic leukemia, which she was diagnosed with at age 5.
“I know I have to stay away from certain stuff; of course, most of it is stuff I would never want to do,” said Abigail, who lives in Hollywood. “I would never want to smoke; that would be terrible.”