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'the way we're curing our patients is through poisoning them'

treatments for cancer in kids, while mostly effective, also cause serious side effects, something one of canada's leading pediatric oncologists hopes investment in research will change.

by karen hawthorne

feb 15 2022

6 minute read

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'the way we're curing our patients is through poisoning them'

although successful for most children, current treatments for cancer also come with short-term side effects like nausea and hair loss. getty

“the reality is that the way we’re curing our patients is really through slashing and burning and poisoning them, and it’s increasingly crude in the 21st century,” says dr. james whitlock , director of the garron family cancer centre at the hospital for sick children in toronto and chair of c17 , the national organization for canadian childhood cancer and blood disorder centres.

he has worked as a pediatric cancer specialist for 30 years, and has seen the wins and challenges of helping kids and their families get through what could be a fatal diagnosis.

consider the numbers. more than 10,000 children, adolescents, and young adults in canada are in treatment or five-year follow-up for cancer right now. about one in five children will not survive cancer, and outcomes worsen for hard-to-cure cancers. ninety-five per cent of survivors will live with a chronic health problem by the time they are 45-years-old.

treatments work, but have ‘baggage’

although successful for most children, current treatments for cancer also come with short-term side effects like nausea, vomiting, hair loss, low blood counts, and increased risk of infection because patients have a weakened immune system, says whitlock.

and the negative impacts don’t end there.

“[treatments] also have long-term side effects,” he says. “many of the drugs that we use to treat our patients, as well as radiation therapy, can affect the heart, the lungs, all of the internal organs. they can also affect bone health and normal childhood development. so, these tools work, but they have a lot of baggage with them .”

part of the negative impacts of treatment simply has to do with age. normal brain cells, for example, grow quickly in the first few years of life, making them very sensitive to radiation. kids treated for cancer — acute lymphoblastic leukemia (all) is the most common childhood cancer (33 per cent of cases), followed by brain and nervous system cancers (20 per cent) and lymphomas (11 per cent) — can have learning disabilities, trouble with memory and attention, and behavioural problems.

radiation can also affect the pituitary gland, which is at the base of the brain and a key player in hormone control in the body. as children continue to develop post-treatment, they may experience fatigue, listlessness, poor appetite, cold intolerance and constipation, which may point to low levels of certain hormones. the result can be delayed growth and sexual maturation.

treatment impacts also often follow survivors of childhood cancer into adulthood, contributing to almost twice as many chronic health conditions, on average, by age 50, compared to the general population, according to the st. jude lifetime cohort study . the study, which brings long-term survivors back to the st. jude children’s research hospital in memphis for regular screenings throughout their adult lives, has found that many survivors have four chronic issues — most commonly heart disease, heart rhythm disorders, high blood pressure, diabetes and obesity, while the more serious are lung function problems, spinal disorders and second cancers.

childhood cancer from a parent perspective

every time laura birkett of niagara falls, ont. has to consent to cancer therapy drugs for her five-year-old son adrian, she’s told about the challenges he could face.

“certain drugs do certain things, so for one of [the drugs] they sat us down and talked about fertility,” she says. “he’s also had a couple heart echoes because they have to check how his heart is managing the medication. but what’s the alternative?”

adrian was diagnosed in july 2021 when severe breathing issues brought him to the er where a chest x-ray revealed a collapsed lung. he was sent to mcmaster children’s hospital in hamilton for emergency surgery and diagnosed with t-cell lymphoblastic lymphoma , an aggressive cancer that has a survival rate of 80 to 90 per cent in kids, but only 25 per cent if there’s a relapse.

he has endured months of chemotherapy, drugs, physiotherapy and had a port implanted in his chest to receive medication more easily. and though he has responded well to treatment, it was not without difficulties.

“he blew up on the steroids, and by the end, i couldn’t recognize his face,” says laura, adding that there were also a lot of days that his energy was so good that you would never know he had cancer.

if all goes well, adrian will be in maintenance care in about a month — which is less intense — taking oral chemotherapies at home and receiving iv chemotherapy in the hospital clinic once a month.

every time laura birkett of niagara falls, ont. has to consent to cancer therapy drugs for her five-year-old son adrian, she’s told about the challenges he could face. getty

new treatments ‘exciting’

while whitlock agrees that the level of care and treatments have advanced tremendously, he’d like to see the management of childhood cancers have less of an effect on the future health of survivors.

“it’s really exciting to be living in an era in which we now have completely new treatment paradigms that we didn’t really have for children 10 years ago,” he says. “[but] it’s not only about saving the 20 per cent of children that we can’t save now, but also finding ways that are more effective and less toxic than the poisons that we use to cure so many of our patients.”

scientific research is a key part of the answer to making change, says patrick sullivan, a vancouver lawyer, as well as a member of the board of directors for childhood cancer canada . he is one of many advocates determined to see leading cancer treatments get to kids in a timely way. his son finn was diagnosed with rhabdomyosarcoma in 2007, a disease where malignant cancer cells form in muscle tissue. the family was told there was a 70 per cent chance of survival, but the cancer returned in 2008 and finn died at age three in october that year.

sullivan cites immunotherapies and genomic sequencing that may help kids with difficult-to-cure cancers like finn’s. with immunotherapy, scientists are now able to harness a patient’s immune system to better fight cancer. early phase immunotherapy clinical trials, such as chimeric antigen receptor (car) t-cell therapy, for example, are producing “unprecedented” remission rates of more than 90 per cent in patients with relapsed disease . but there are only a few of these trials underway, including one at the hospital for sick children, with limited access, partly based on proximity to treatment centres.

and although most of these methods have become standard in the care of adults, children have not had the same access to potentially lifesaving treatments because they are considered a vulnerable population that has to be protected from the risks of medications that are still in clinical trials, says whitlock.

“that’s been one of the challenges, not just in canada, but everywhere, in providing access to children,” he says.

and then there’s the cost of research and development, towards which the federal government pledged $30 million for canadian institutes of health research (cihr) studies into pediatric cancer with an aim to improve outcomes for children with cancer.

“i would like to see this money spent in such a way that we are closing the gap for access and providing better answers for families who are going to be faced with the words, ‘your child has cancer,’” sullivan says.

from where he sits on the frontlines of childhood cancer treatment, whitlock has hope.

“i can see in the not too distant future a day when these treatments, these immunotherapies and precision medicines actually replace the poisons,” he says. “instead of being in the hospital for days or weeks at a time, they can take a pill.”

great news for the families of the future whose children will face a cancer diagnosis. as for laura birkett, when she talks about her son’s cancer experience, she uses words like, ‘normal’ and ‘good days.’

“it’ll be a big part of your life, but it won’t be your whole life,” she says. “you’ll still have that kid that you’ve always known and you’ll still have good days. it’s just a new normal.”

more information on childhood cancer can be found by visiting the childhood cancer canada or the canadian cancer society .

karen hawthorne is a toronto-based freelance writer.

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karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto as a freelancer, and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

'the way we're curing our patients is through poisoning them'

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'the way we're curing our patients is through poisoning them'

treatments for cancer in kids, while mostly effective, also cause serious side effects, something one of canada's leading pediatric oncologists hopes investment in research will change.

treatments work, but have ‘baggage’

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