Cover story for Pulse@UM Year 2020 Issue 3: Health at the crossroads – An interdisciplinary approach

Healthy Adult Life Following Childhood Cancer

By Professor Dr Hany Ariffin, Associate Professor Dr Tengku Ain Kamalden & Dr Norsafatul Aznin A. Razak

Background
Large epidemiological studies have shown that nearly two-thirds of childhood cancer survivors (CCS) develop at least one serious health condition, i.e. late effects, in their lifetime (Oeffinger, 2006). In 2015, the paediatric oncology research group conducted a surveillance study on long-term survivors treated at the University of Malaya Medical Centre (UMMC). It is found that young adult survivors of childhood leukemia had a higher prevalence of metabolic syndrome compared to controls (18.4% vs 4.6%). Additionally, approximately 50% of CCS had >1 criteria for metabolic syndrome despite only being in their midtwenties
(Ariffin, 2017).

As >80% of children are expected to survive cancer in the modern era, concrete steps are needed to: [1] address areas of physical and cognitive deficit; [2] develop effective health screening tools and [3] develop better therapies which limit treatment-related organ damage.

Harnessing the Power of Educational Psychology
Since 1980, over 200 children with brain tumours have been treated in UMMC with a survival rate of 60-70%, comparable to developed countries. Unfortunately, therapies for brain tumours lead to many long-term and devastating side-effects. Notably, cranial irradiation is associated with neurological deficits such as deterioration of IQ and poor memory (Ries, 2008). Additionally, as the child with brain tumour transitions into adolescence and adulthood, he/she often faces academic and psychosocial challenges (Langeveld, 2004).

In collaboration with researchers from the Faculty of Education and funded by a UM grant (IIRG-021B), an intervention programme for survivors of brain tumours was launched in 2019. The multi-faceted programme includes individual and family therapy and counselling, psychological rehabilitation and cognitive behavioural based interventions. Of note, due to the restrictions arising from the Covid-19 pandemic, these programmes have shifted to the online platform, ensuring continuity of care for the patients. 

Eyes as Windows to the Heart
The eye is the only privileged organ where blood vessels and unmyelinated nerve fibers can be seen and examined directly. The eyes have proverbially been touted as ‘windows to the soul’ but now also serve as a screening tool for heart disease. Working together with the UM Eye Research Centre and collaborators from Universities of Edinburgh and Dundee, retinal vessel analysis using software named VAMPIRE (Vascular Assay and Measurement Platform for Images of the Retina) was performed to identify CCS at increased risk for developing cardiovascular disease (Azanan, 2020). At-risk survivors were identified using images taken via a retinal camera to seek evidence of microvasculopathy (vascular attenuation). This, in addition to physical and biochemical evidence of endothelial dysfunction, facilitated identification of at-risk patients and allowed implementation of appropriate intervention measures.

Developing Better and Safer Therapies
Treatment protocols for childhood cancers have focused on achieving an optimal balance between cure and toxicities. Modern treatment protocols such as the sequential Malaysia-Singapore leukaemia (MaSpore-ALL) clinical trials are risk-adapted based on better understanding of tumour biology and treatment response to improve therapeutic precision. Hopefully, these efforts will yield the ultimate prize of excellent cure rates with minimal longterm side-effects; thus allowing childhood cancer survivors to lead healthy and productive adult lives. 


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