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More Children Suffer from Chronic Disease, Study Finds

June 26, 2007 at 6:40 PM EDT
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JUDY WOODRUFF: In a special issue devoted to childhood diseases, today’s Journal of the American Medical Association published a series of studies on the progress and problems of battling cancer, diabetes, and other chronic diseases.

Nearly 10,000 children will be diagnosed with cancer in the U.S. this year; roughly 80 percent will survive five years or more with treatments. But a report in today’s Journal finds many survivors are dealing with serious health problems from those treatments afterwards.

The Journal also reported rising numbers of children developing either Type 1 or Type 2 diabetes. More than 175,000 people age 20 or younger in the U.S. have diabetes.

For more on these findings, we turn to Susan Dentzer of our Health Unit. The unit is a partnership with the Robert Wood Johnson Foundation.

Susan, first, the survivors of childhood cancer, what did the researchers find?

SUSAN DENTZER, NewsHour Health Correspondent: Well, Judy, as we just said, the good news is that about three in four children treated for cancer in the U.S. and other developed countries, like those in Europe, do survive and go on to live long lives. The question is: What are the burdens that are felt by these survivors over the long period of time?

And so a Dutch study that was published, as we said, took a look at children who had survived cancer treatment from a children’s hospital in Amsterdam over the course of a 30-year period. They found about 1,300 of those survivors, and they asked: What were the long-term consequences? Did they have serious adverse events? Did they have secondary tumors? Did they have heart issues that resulted from their various cancer treatments? Do they have cognitive impairment, other things like that?

What they found was that — the good news was that 20 percent of children did not have any adverse effects, as they grew up and became young adults and older adults. However, 75 percent of those treated for childhood cancer did have some kind of event, adverse event; 40 percent had a serious or life-threatening event; 25 percent had five or more adverse events.

And the researchers concluded this was a very high burden of illness to accompany that long-term recovery process.

How to treat childhood cancer

JUDY WOODRUFF: So this was not what they expected to find?

SUSAN DENTZER: It was a little higher than, say, one recent U.S. study had found on the same question. And, again, these are comparable issues in the Netherlands and the U.S., in terms of the types of cancers that children were experiencing and the treatment and so on.

JUDY WOODRUFF: What does this say -- and so, just to clarify, this was done in the Netherlands, but because of the types of cancers, they have other reasons to think that it does apply here in the United States?

SUSAN DENTZER: Very much applicable to the U.S., that's right.

JUDY WOODRUFF: What does it say about what should be done, are the researchers saying, to treat -- in the treatment of childhood cancer, and then beyond, given what they've found?

SUSAN DENTZER: Well, one thing is they continue to look for treatments that minimize these long-term consequences. For example, in this study, what was clear is that children who have been treated with radiation had the highest rates of adverse events. Radiation can cause radiation to the chest, can contribute later on to breast cancer. Radiation to the head and neck, surprisingly, can contribute to obesity later in life.

So the researchers emphasize continuing to look for treatments that minimize radiation, target it a little bit more carefully, or shift to other treatments. Interestingly enough, chemotherapy resulted in relatively less rates of adverse consequences over time as compared to surgery. So look for new ways to treat children. Look for more targeted therapies that are coming on the market now, et cetera.

Another very important thing that researchers said was that children who have been treated for cancer need to be continuously monitored over the course of their lifetimes, and probably treated in specialized clinics by trained physicians and other health providers who really know what to look for, because a lot of these things that these children will experience are themselves treatable, like heart disease, for example, vascular kinds of issues, circulatory issues. Those things can, indeed, be treated, provided that they're found and monitored.

I rise in diabetes

JUDY WOODRUFF: Interesting and troubling in many ways.

Now, Susan, the other interesting, I guess, most interesting finding you and I were discussing was that diabetes rising among children. Which type, or both types?

SUSAN DENTZER: Well, there are two types of diabetes, as you say. Type 1 diabetes is actually an autoimmune condition. It's usually found in young children, starts in young children. It's when the immune system, for some reason, attacks the so-called beta cells in the pancreas that produce insulin. Therefore, you don't have enough insulin. Insulin is the hormone that allows your body to process the blood sugar, and that is the fuel for cells. So if you don't have that, that's obviously a very bad thing.

Type 2 diabetes, by contrast, usually -- we used to call that adult-onset diabetes, because it usually was found much later in life. Now it's increasingly found in children. And, in effect, what happens there is the body is either resistant to the insulin or, again, doesn't manufacture enough insulin, so you have similar issues that result. Your body cannot process the blood sugar, and long-term consequences can be really quite disastrous.

JUDY WOODRUFF: And both types they found to be increasing. Why?

SUSAN DENTZER: Yes, well, the Type 1 diabetes, again, used to be referred to largely as juvenile diabetes. They found that there are basically about 15,000 new cases being diagnosed now each year, was the estimate coming out of a study. That appears to be going up for reasons that really are not understood.

Type 2, the formally adult-onset type, is very much linked to obesity and genetics, but particularly obesity. And so we've expected, as the rates of obesity in children have tripled and even close to quadrupled over the last 30 years, we've seen those rates of Type 2 rise.

A new hypothesis is that the same factors that are driving the rise of Type 2 diabetes in children is actually also driving the increase in Type 1 diabetes. Again, it's a hypothesis. We don't know why; we don't know if the body is just becoming overwhelmed, that the beta cells in the pancreas are being becoming overwhelmed in the course of obesity. It's really not clear what's happening. So the researchers in this case called for a lot more research to understand why these rates are rising.

They also looked specifically at the fact that, who is getting these two types of diabetes? They found that the Type 1 diabetes is much more prevalent in white children, non-Hispanic white children. They found that the Type 2 diabetes is much more prevalent and has its highest prevalence rates in American Indian children, in African-American children, and Asian and Pacific Islander children.

"The watchword is 'prevention'"

JUDY WOODRUFF: But they don't know why again?

SUSAN DENTZER: Well, the supposition is that it's some interaction between underlying genetics and environment. And the environmental exposure here is really obesity, lack of activity, poor diet.

JUDY WOODRUFF: And, again, are researchers coming away from this with some sense of what should be done now in treating or anticipating diabetes that they didn't know before?

SUSAN DENTZER: And the watchword is "prevention." Again, as we see these rising obesity rates in children and the concomitant rise in Type 2 diabetes, the thing that everyone is calling for is prevention: more exercise, better diet, better food choices in children, anything that we can possibly do to stop this, in effect, what is becoming a pandemic.

Thirty percent of Medicare spending is related to diabetes. The average diabetes patient on Medicare will cost about $32,000 to treat. If children are in their teens developing conditions that we used to not expect people to develop until their forties or fifties, we're really going down a very dangerous road and a very costly road for the United States.

JUDY WOODRUFF: And once you have diabetes, you have it for life?

SUSAN DENTZER: Absolutely. And, again, the consequences in terms of blindness, amputation, and, of course, eventual death can be enormous, if it's not controlled.

JUDY WOODRUFF: Susan Dentzer, thank you very much.

SUSAN DENTZER: Thanks, Judy.