Reality Check: We Are Nowhere Close to Solving the Problem of Childhood Cancer
By: Gregory J. Aune, MD, PhD
Since President Obama announced the Cancer Moonshot in his State of the Union address, various media outlets have been reporting on the overall effort to fight childhood cancer in the United States. The reports seem to suggest that we have beaten childhood cancer.
We have not.
Death from childhood cancer is not rare. Although cure rates have improved significantly since the 1950s, childhood cancer remains the number one cause of death by disease for children in the United States.
There’s bad news for the quarter of a million children diagnosed with cancer worldwide, too. Cure rates in low- and middle-income countries are significantly lagging, making premature death from childhood cancer a major worldwide problem.
The positive media focus on childhood cancer seems to be stemming from a publication that came out of the ongoing Childhood Cancer Survivor Study (CCSS), which follows over 30,000 long-term survivors of childhood cancer. The publication points to lower late mortality rates for patients treated in the 1990s compared to those treated in the 1970s. It concludes that modified treatment strategies aimed at reducing the survivors’ long-term health burden are working.
It’s true that we are making progress against childhood cancer, as this study suggests. But when media outlets only highlight the successes in cure rate statistics, they ignore the significant challenges that remain.
There have been few breakthroughs for many types of childhood cancer, and treatments still depend on toxic regimens developed decades ago. Because there are fewer pediatric cancer patients than adult cancer patients, pharmaceutical and biotechnology companies don’t have a financial incentive to invest in new drug development. So in the last 30 years, only three new drugs have been successfully developed and approved for childhood cancers, compared to dozens for adult cancers.
Yes, researchers have improved some therapy options, and our basic scientific knowledge of pediatric cancers has advanced. But this knowledge hasn’t resulted in clinical improvements. And without that, one in every five children diagnosed with childhood cancer is left with little hope.
Unfortunately, even patients that survive must endure months, even years, of toxic treatments. Patients face repeated hospital admissions, intense vomiting, extreme weight loss, life-threatening infections, and even seizures and strokes. Cancer treatment devastates kids and their families physically, emotionally, and financially.
The media glosses over these realities by focusing on the 80% “cured.” They’re not giving the full picture.
What we ask our patients to overcome for long-term survival is simply too much.
By 2020, there will likely be over 500,000 long-term childhood cancer survivors living in the United States. For them, late health effects are a huge problem. Researchers estimate that in childhood cancer survivors, the chance of either dying or developing a life-threatening health problem caused by previous cancer treatment approaches 60% by age 50. Most live with serious health challenges long after they are “cured.”
As a childhood cancer survivor, I have benefited directly from the incredible advances made in the field of pediatric oncology over the last 70 years. I am thankful that the media outlets remind us to celebrate. But let’s not forget the remaining challenges: far too many children still die, and too many survivors live with the devastating effects of their treatment.
New strategies to treat all types of cancer, including immunotherapies and targeted treatments matched to an individual patient’s genes, are very promising. But we need to make sure that children are included in the research as clinicians perfect these treatment strategies.
Because childhood cancer research gets minimal funding from private industry and depends so heavily on government investment, childhood cancer should be a national priority in Vice President Biden’s moonshot initiative. It just makes sense.
I urge the Vice President to push cure rates for children with cancer to 100% and to eliminate the long-term health burden on survivors.
Our children depend on it.
Dr. Gregory Aune is a St. Baldrick’s Scholar at Greehey Children’ Cancer Research Institute in San Antonio, Texas. A childhood cancer survivor of 25 years, Dr. Aune has experienced many late effects of treatment, including infertility, stroke, and life-threatening heart disease. Read more about his story here.