Cancer stories in 'The Fault in our Stars' highly unlikely, pediatric oncologist says

News Archive May 21, 2014

Cancer stories in 'The Fault in our Stars' highly unlikely, pediatric oncologist says

In real life, most kids have better outcomes
MAYWOOD, Ill. (May 21, 2014) – If the upcoming movie “The Fault in our Stars” is faithful to the best-selling book, the three main characters will experience cases of pediatric cancer that are highly improbable, according to a Loyola University Medical Center pediatric oncologist.

The cancer cases depicted in the novel are “not impossible,” said Charles Hemenway, MD, PhD, who treats children and adolescents who have cancer, “but the cases would be most unusual."

The movie, which opens June 6, is based on the young adult novel by John Green. In Green’s novel, teenage cancer patients Hazel Grace Lancaster and Augustus Waters fall in love. Hazel has thyroid cancer that has spread to her lungs and does not expect to live long. Augustus has osteosarcoma (bone cancer). Following a leg amputation, Augustus appears to be cancer-free. But then the cancer spreads, and at the end of the book, Augustus dies.

Several aspects of Hazel’s case are unusual. Thyroid cancer is rare in people under age 20, accounting for less than 3 percent of all cancers. This cancer usually is detected before it spreads. And when it does metastasize, the cancer usually can be treated successfully with radioactive iodine, which specifically targets cancer cells and destroys them, Hemenway said. The long-term survival rate of pediatric thyroid cancer is greater than 95 percent.

Augustus’ case is perhaps not as unusual. Osteosarcoma accounts for about 5 percent of all pediatric cancers and is the most common bone cancer. Tumors typically occur in the long bones (shin, thigh and upper arm) and usually develop during growth spurts in the teenage years. Treatments include chemotherapy and surgery to remove the tumor.

Some patients undergo amputations, but in other cases the arm or leg can be saved. It’s possible for the cancer to spread after an amputation, but it typically spreads just to the lungs. But in Augustus’ case, it spreads everywhere. (He tells Hazel, “I lit up like a Christmas tree.” The long-term cure rate is 65 to 70 percent, Hemenway said.

The most unlikely case involves a third teenage character, Isaac, who attends a support group with Hazel and Augustus. Isaac, who lost one eye to cancer when he was a child, learns that his second eye will also have to be removed.

The most common form of eye cancer affecting children is retinoblastoma. It occurs in babies and toddlers, but it is extremely rare in teenagers. Treatments include chemotherapy if the tumor is very large and cryotherapy, which kills cancer cells with extreme cold. It is possible for a patient to lose one eye to retinoblastoma. But in such cases, physicians would keep an extremely close watch on the other eye and most likely would be able to successfully treat any recurrence, Hemenway said.

“Isaac’s case is a pretty unlikely scenario,” Hemenway said.

Fortunately, most pediatric cancer patients experience better outcomes than Hazel, Augustus and Isaac did. Pediatric cancers are biologically different from adult cancers and children generally are able to tolerate higher doses of chemotherapy, Hemenway said.
The overall cure rate of pediatric cancer is about 70 percent and is even higher for some of the most common childhood malignancies.

“However, the impact on children’s cognitive, psychological and social development can be tremendous,” Hemenway said.

In the novel, the support group meetings for teenage cancer patients are grim affairs. In real life, support groups are more fun, with kids doing activities such as camping and art therapy, said Megan Gertz, child life coordinator at Loyola’s Ronald McDonald Children’s Hospital.

“They do a lot more than just sitting around in a circle talking about their cancers,” Gertz said.

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.
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