Obesity increases one’s risk for several serious health conditions, from heart disease to cancer. Survivors of childhood cancer who become overweight or obese as adults are at an increased risk of developing an obesity-related cancer. If these survivors were obese as children and carry that obesity into adulthood, they are at even higher risk.

So how does being overweight/obese put you at risk for cancer? Higher amounts of body fat cause chronic inflammation in the body, which has the potential to damage our DNA, and in turn, cause cancer.

At highest risk of obesity are childhood cancer survivors of ALL (Acute Lymphoblastic Leukemia) or those who received radiation, more specifically brain, abdominal, and total body irradiation (TBI). ALL puts survivors at risk for obesity due to the use of steroids during treatment. Radiation to the brain can affect the pituitary and hypothalamus, which regulate the metabolic processes in our bodies. Damage to these areas of the brain can lead to over-eating and weight gain.

According to the National Cancer Institute, adults who are overweight or obese are at risk for developing 13 different cancers: meningiomas, adenocarcinoma of the esophagus, multiple myeloma, endometrial cancer, and cancers of the kidney, ovaries, thyroid, breast, liver, gallbladder, upper stomach, pancreas, and colon/rectum. Approximately 70% of adults over the age of 20 are overweight and of that 70%, approximately 36% are considered obese.

 In 2013, there were approximately 42 million children worldwide who were overweight or obese. These numbers continue to rise.

Whether obesity is linked to cancer treatment itself or poor nutritional choices and lack of exercise, it still puts our childhood cancer survivors at an increased risk of cancer in adulthood. So what can we, as healthcare professionals, do to help our patients/survivors lower their risk of obesity and in turn, lower their risk of developing an obesity-related cancer in adulthood? We must educate them!

Educating parents should begin as soon as a child is born. We tend to think babies with multiple leg rolls are just so cute, but what if those cute baby leg rolls turn into an overweight toddler, and so on and so forth? Dietary and physical activity habits develop early on in life and often continue with us as we grow into adults, whether good or bad. Also, when our patients' cancer treatment carries the risk of obesity as a long-term side effect, we must educate the parents about this. Being prepared for the possibility and practicing proper nutrition and exercise may allow them to avoid or at least control the obesity as a survivor.

Obesity, in general, puts every individual at increased risk for cancer in adulthood. Knowing that some childhood cancer treatment protocols increase the risk of secondary cancers makes it more important to tackle the modifiable risk factor of obesity now. These children bravely fought and won, so let's help them be victorious and healthy for the rest of their lives!

Nishtar, Sania. Global Child Obesity Epidemic a Huge Risk For Cancer.  

www.wcrf.org/int/blog/articles/2015/02/global-child-obesity-epidemic-huge-risk-cancer

. Published February 4, 2015. Accessed on March 15, 2018.

National Cancer Institute.  Obesity and Cancer. 

www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet

. Published January 7, 2017. Accessed on March 15, 2018.

Articles

Survivors of childhood cancer who are overweight or obese as adults are at an increased risk of developing an obesity-related cancer.

Obesity and Childhood Cancer

I recently had a cancer mom message me. Here’s what she said: “I am struggling this week. An agent I worked with who called and checked in on my daughter from time to time during her treatment, lost his grandson this week to cancer—brain tumor after only a short 5-month battle. He was only 20 months. I am having a terrible time trying to go to the funeral tomorrow. So many mixed feelings. Yet I’m trying to be comforting to those that comforted me. He would call from time to time asking questions and for encouragement during his grandson’s treatment. His daughter is only 19, and lost her baby to cancer. Ugh…hard week…and I know it’s not about me. It’s about them. There are just lots of feelings of guilt — terrible guilt of having a survivor, which shouldn’t feel guilty about at all. Cannot find the words. I know this is a heavy message, just hard to find those that understand or even relate.”

Woah. My first thought was “What do I say in response to that?” Then my heart broke into a million pieces as the gravity of what she just told me sunk in. She feels guilty that her daughter survived cancer?   

Being a pediatric hematology/oncology nurse, I try my best to empathize with the families I care for. No matter how hard I try to understand what they’re going through, I have come to the realization that I truly cannot fathom the depth of the emotional rollercoaster that accompanies childhood cancer. Her message opened my eyes to the world of guilt and blame these parents endure every single day during their child’s cancer journey…a journey that continues long after treatment ends.   

The end of treatment is a joyous time, but it can also bring with it an entirely new set of emotions. Many parents find themselves wondering, “Why did my child survive and my friend’s child did not?” This is referred to as “survivor’s guilt” and though the thought may seem illogical to those of us who haven’t been through it, it is very real to them. According to Rhonda Colley, a mind-body therapist at Cancer Treatment Centers of America in Tulsa, Oklahoma, “The feeling of guilt is real, but the foundation of it is imagined.”

So, what do we say when one of our parents expresses survivor’s guilt?

Encourage them to talk about their feelings. If they’re not comfortable expressing their feelings verbally, encourage them to journal. Recommend attending a support group or talking to a therapist. Another effective way to deal with survivor’s guilt is to give back. Volunteering their time at a local cancer treatment center is just one of a multitude of ways.   

After researching “survivor’s guilt,” I also found that “self-blame” is quite common among caregivers of childhood cancer patients. We as parents are supposed to protect our children, right? I often hear parents express concern that their child’s cancer was caused by something they did or did not do. “I should have taken him to the doctor earlier” or “I should have fed him more vegetables.” It’s important that we allow them to express these feelings, but we must also educate them that childhood cancer is not like adult cancers, which can sometimes be linked to lifestyle factors. The causes of most childhood cancer are unknown. It’s not the parent’s fault that their child was diagnosed with cancer.  

Dwelling on feelings of guilt and blame are not healthy and can lead to depression. Acknowledging these parent’s feelings should be a priority, followed by getting them the help they need to leave the guilt and blame behind. The survivor and their parents deserve to enjoy their precious lives!          

Guilt is common among caregivers of childhood cancer survivors.

Guilt, Blame, and Cancer

Sex.  There, I said it.  The subject is uncomfortable for many under normal circumstances. When it comes to an adult cancer patient, the subject is often neglected, positioned far down on the priority list of things to be addressed.  With childhood cancer patients, the subject is almost forgotten in the midst of the chaos of treatment. Who ever said that cancer patients, young or old, don’t have sex?  Why, as health care professionals, do we often make that assumption and/or fail to address the subject? They are still human, right? Dispelling that myth is the first step in being able to provide the most comprehensive care possible during their cancer journey. 

Adolescents and young adults often engage in risky health behaviors in general, and risky sexual behavior is no exception.  For survivors of childhood cancer, though, the importance of abstaining from or at least limiting risky sexual behavior is of utmost importance. Risky sexual behavior among childhood cancer patients/survivors can be associated with disrupted physical development, as a means to feel “normal” like their peers, and because of the misconception that because they received chemotherapy, they are infertile.

First, we should address whether it’s “safe” to have sex during treatment so we can provide the most accurate answers when the subject is addressed.  I can honestly say, that until my recent change in jobs, I never took the time to research the subject, in part because I was so focused on the acute side of cancer care.  St. Jude Children’s Research Hospital has published some safe “guidelines” in regards to sex during treatment:

·       Platelet count should be at least 50,000

·       Wait at least 72 hours after chemotherapy to have sex, whether that be vaginal, oral, or anal

Now that we know that it is “safe” as long as the above guidelines are followed, we should also address the need for precautions to reduce the risk of pregnancy during treatment. We all know that chemo and radiation attack fast growing cells, whether cancerous or not. This includes sperm and eggs, which could lead to significant birth defects in a baby. Some patients assume that they are infertile since they’ve had chemotherapy and/or radiation. It’s important to stress to your patients that they should assume they are fertile unless proven otherwise. We must also educate them on the importance of protecting themselves from infectious diseases, as they are at increased risk of developing HPV-related malignancies as adults. This can be attributed to the treatment they received.

Unless proven that the individual is infertile, education and counseling regarding short and long term side effects from the treatment received should be provided, ideally starting during treatment. Patients often find it difficult to start the conversation with their provider about physical and psychological sexual issues they may be having as a result of cancer treatment, thinking it is far down on the list of priorities. We as oncology healthcare providers need to become comfortable with bringing up the subject so our patients don’t have to. We are doing them a disservice if we don’t help educate them on possible sexual-related side effects from their treatment and what steps can be taken, if any, to preserve their fertility.   

Talk about what no one wants to talk about. Let’s help make this subject not so taboo and more just a routine conversation we have with our patients and survivors, whether adult or pediatric.

Who ever said that cancer patients, young or old, don't have sex?

Approaching a Taboo Topic: Sex During Cancer

Jennifer Brown, RN, BSN, CPN, CPHON has worked as a pediatric nurse for 16 years. She has taken care of pediatric hematology/oncology/stem cell transplant patients in some capacity her entire career. Having been a caregiver to 2 family members with cancer, Jennifer is dedicated to raising awareness about all types of cancer.

Jennifer Brown RN, BSN, CPN, CPHON

Articles

Obesity and Childhood Cancer

Guilt, Blame, and Cancer

Approaching a Taboo Topic: Sex During Cancer