Helping hand for child cancer survivors

SINGAPORE - Cancer survivor Joyson Tan had a worry-free Christmas last year.

Not only did the 13-year-old get to enjoy the festive lights, he indulged in turkey, ham and sausages - processed meat that was previously taboo because of his bone marrow transplant.

He got to enjoy the food because Joyson is getting support from a clinic that has been set up specially to help patients like him.

Last March, the National University Hospital (NUH) set up a late effects clinic to help both young cancer survivors and their parents.

Joyson was diagnosed in 2007 with acute bi-lineage leukaemia, meaning he had two types of blood-cell cancer at once.

CHEMOTHERAPY

He had undergone intensive chemotherapy and a bone marrow transplant in October that same year.

Just when Joyson thought he was out of the woods, he has to deal with the long-term effects of his cancer treatment.

These include hypothyroidism, ulcers in the mouth and cataracts in both eyes.

He continues to be on medication to manage his thyroid, his mother, Mrs Cyndy Tan, 42, said.

"And because he was very ill and weak, we tended not to let him go out and play in case he exerted or hurt himself.

Now we will try to encourage him to go out in the sun and do exercises to build up his bones," she told The New Paper.

Like Joyson, many child victims of cancer - about eight in 10 - managed to beat the big C, but ended up having to deal with long-term side effects.

These usually manifest years later, affecting the child's health and growth.

One of the more common late effects caused is hormone disturbance.

It affects up to four in 10 patients and can result in either early or late puberty, depending on the type of treatment received.

So NUH set up the clinic to help the young patients.

Helmed by a team comprising a child cancer doctor, a gland specialist and a nurse, the team monitors young patients closely.

Paediatric oncologist and haemotologist Tan Poh Lin with NUH said the clinic currently sees between 50 and 60 patients who had undergone transplants from as recently as about six months to as long as 10 years ago. A couple of the patients are now adults in their 20s.

"Most of these kids had high-risk leukaemia and needed high dosage of chemotherapy to manage the cancer before going in for the transplant. This high dosage can damage cells and keep them from growing and developing the way they should," she said.

Paediatric endocrinologist Lee Yung Seng said the glands are the most "hardworking part of the body".

"Yet they are most susceptible when it comes to chemotherapy. When breaking down, some of the glands manifest as growth failure," Associate Professor Lee said.

He said these children often develop hypothyroidism, the abnormally low activity of the thyroid gland that results in retardation of growth and mental development in children and adults.

"These issues surface years later and become more and more progressive.

Therefore these kids and young adults need to have constant surveillance," he said.

Another important factor that is affected is the sex hormone that is important for development and bone health, Dr Tan said.

"Many of them develop osteopenia (a condition where bone density mass is lower than normal) which is discovered during bone density scans," she said.

Mrs Tan said: "It is a long road to recovery and regaining health and I'm glad the doctors who saw him through his cancer are committed to help Joyson - and other children like him - along the way."


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