Although breastfeeding may be impaired in some survivors of childhood cancers as a result of treatments, such women who are able to successfully breastfeed should do so, because of the protective effects it can impart,1 according to research led by Susan W. Ogg, RN, MSN, a re search nurse in the Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee. “Some nurses work with women and assess their lactation potential throughout pregnancy, labor, delivery, and postpartum,” Ogg said. “When working with a mother who has survived childhood can cer, we recommend that nurses or other medical professionals conduct more frequent breast exams to monitor the survivor’s lactation potential. [That way], if it appears that the survivor may be unable to lactate, she can be better prepared to employ other nutritional options in the postpartum context.”
Ogg, James Klosky, PhD, a clinical psychologist at the St. Jude Children’s Research Hospital, and colleagues also strongly advocate for breastfeeding whenever possible among childhood cancer survivors.
“It is one more health behavior that survivors can engage in to promote their own health and their children’s health,” Klosky said. “Furthermore, breastfeeding may alleviate some of the potential late effects of childhood cancer therapy experienced by these mothers.”
In the study, the researchers re iewed the scant amount of literature addressing lactation outcomes in patients with cancer, as well as the evidence for benefits of lactation to cancer survivors. “This is the first paper to provide an overview of the whole topic,” commented Pamela Berens, MD, professor of obstetrics and gynecology at the University of Texas Health Science Center at Houston, who was not one of the researchers. “We need better longterm research, and the time is ripe for both retrospective and prospective studies, as the authors point out, since quite a number of women have survived childhood cancer.”
The small number of studies on lactation and breastfeeding in cancer survivors all point to lower rates of lactation, and not only among breast cancer survivors. For example, a study of long-term survivors of Hodgkin lymphoma showed that only 61% of women’s breastfeeding attempts were successful compared with 79% of attempts in a sibling control group.2 Another team reviewed the lactation experiences of 12 survivors of childhood acute lymphoblastic leukemia.3 Every woman had received 24 to 25 Gy of cranial radiation therapy and chemotherapy as part of treatment, and only 17% were able to breastfeed.
One mechanism for the lactation difficulties appears to be a growth hormone deficiency; cranial radiation is linked to a high risk for such a deficiency, the researchers point out. They also outline the salubrious effects of breastfeeding, including:
“We propose that education of childbearing cancer survivors about the health benefits of breastfeeding should be added to the list of interventions that are commonly recommended to cancer survivors,” the researchers concluded. They also stressed that healthcare professionals who have patients with childhood cancer should be aware of the potential deleterious effects of the cancer treatment on lactation, as well as the likely benefits of breastfeeding for infants and mothers.
References
1. Ogg SW, Hudson MM, Randolph ME, et al. Protective effects of breastfeeding for mothers surviving childhood cancer. J Cancer Surviv. 2011;5:175-181.
2. McCullough L, Ng A, Najita J, et al. Breastfeeding in survivors of Hodgkin lymphoma treated with chest radiotherapy. Cancer. 2010;116:4866-4871. 3. Johnston K, Vowels M, Carroll S, et al. Failure to lactate: a possible late effect of cranial radiation. Pediatr Blood Cancer. 2008;50:721-722.
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