As it turned out, Erin Hannagan was one of the lucky ones.

Hannagan was 16 when she was diagnosed with Hodgkin’s disease May 25, 1993. But she would beat the disease.

“I had been coughing for quite some time and had been diagnosed with multiple ‘colds,’” Hannagan recalled. “It finally got so bad that my mom took me to an urgent care center where a chest X-ray was done that revealed a large mediastinal [cavity containing the heart, esophagus, trachea, thymus and aorta] mass.”

Hannagan was home from school the next day when the physician’s assistant called and asked to speak to her mother.  

“When he asked for her work number I remember being worried,” she said. “When my mom arrived home shortly afterward I knew something was up.”

Hannagan and her mother went to Upstate Medical University to the Center for Children’s Cancer and Blood Disorders.  

“I still remember crying when Dr. Dubowy and Dr. Kennedy knew my name before we told them,” she said.

Dr. Gloria Kennedy, then a fellow at Upstate, became Hannagan’s primary physician. She got Hannagan enrolled in a clinical trial, where she was treated with chemotherapy and radiation over the next year.

‘Treatment was okay, [but] it was chemo after all,” Hannagan said. “I had three inpatient courses and I was sick then.  But my friends and family always came to the hospital to keep me company.”

Hannagan said she tried to stay as “normal” as possible, managing to remain involved in her extracurricular activities like cheerleading.  

“I think that you kind of get used to feeling a little bit sick a lot,” she said. “The hardest part about treatment was definitely when my hair fell out. It seemed very real after that happened. I think I dealt with it pretty well emotionally.  It was hard on my family and my sisters, though, I think. But our family is closer as a result.”

Though she remembers the exact date of her diagnosis, Hannagan said she doesn’t recall exactly when she found out she was in remission, though she knows it was on a weekend.

“Dr. [Irene] Cherrick [another oncologist at Upstate] called and told my mom that my scans are all normal,” Hannagan said. “I was already done with treatment at that point, so I guess as a 16-year-old, that was the most important thing.”

Lingering effects

Though her treatments ended some two decades ago, Hannagan still has some lingering effects from her disease.

“As a result of treatment, I have to take medications every day,” she said. “I take medicine for hypothyroidism and hormone replacement. I am seen every year at Upstate’s Center for Children’s Cancer and Blood Disorders.”

And that’s not uncommon. A study published in the New England Journal of Medicine in 2006 found that nearly three quarters of all pediatric cancer survivors will have a chronic health problem within 30 years of their diagnosis, with 40 percent suffering from a serious, life-threatening, disabling or fatal condition. The findings were based on interviews with survivors, questionnaires filled out by those survivors, and analysis of their cancer treatments. The outcomes of the adult survivors were compared to their siblings. Compared to their siblings, adult survivors of childhood cancer were eight times as likely to have severe, life-threatening, or disabling chronic health conditions such as heart attacks, second cancers, and serious problems with cognition (e.g., learning and memory), according to the report.

In Syracuse, after a child has completed treatment, he or she transitions to the Survivor Wellness Center at Upstate Golisano Children’s Hospital, where they will be seen regularly to be screened for any side effects from treatment or other ill effects that may linger for years after the cancer has been declared in remission.

“We provide ongoing medical care to cancer survivors of all ages,” said Dr. Jody Sima, a pediatric oncologist who specializes in cancer survivorship. “Most long-term cancer survivors have complications of their cancer and treatment that can appear many years after treatment is complete. Medical care can improve the symptoms or decrease the severity of these long-term complications.”

The complications vary depending on the cancer for which the child was treated and include second cancers, infertility, cognitive difficulties, slowed or decreased growth or bone development and cardiovascular disease. And because complications often don’t appear until long after treatment has ended, it’s not just children who end up at the Survivor Wellness Center.

“Often, the long-term complications do not appear until 10 to 20 years after the cancer has been treated,” Sima said. “For this reason, our center has been designed to see adult patients. A child who is at high risk for long-term complications may be seen regularly for as long as necessary.”

Sima said it’s important to educate patients and their primary care physicians about the potential late effects of cancer even after it’s in remission.

“The long-term medical complications for cancer are serious, and many physicians are not aware of the risks,” she said. “This is a specialized area of medicine in which few people have training and expertise. That is why our goal is to provide patient care, but also to serve as a resource for other providers. We can see a patient in consultation, and then they can see their primary care doctor or oncologist with the most recent data on long-term complications for that patient.”

Bouncing back

Despite the potential for complications, it’s not all dark skies ahead. The most important battle has been won: the patient has beaten the cancer.

And having won that battle leaves little patients with some strengths their peers don’t have, Sima said.

“Cancer survivors have been shown to have many medical complications, but it is important to know they also have increased resiliency compared to other people their age,” she said. “This means they are more likely to bounce back from stressors later in life.”

Additionally, any complications patients do face can be treated by the Survivor Wellness Center. At least, that was Hannagan’s experience.

“I know that I could always contact Upstate if I needed anything related to my treatment,” she said.

The most lasting effect of Hannagan’s cancer was that it changed her career path. Instead of going into law — “I was really good at ‘debating,’” she said — she became a pediatrician.

“I had always thought that medicine was kind of simple,” Hannagan said. ‘I didn’t realize that there is a lot of investigation that goes into making a diagnosis. After my diagnosis I realized that medicine was not that cut and dried. It takes time. I liked that.”

Her own experience also played a big role in her decision.

“I also had a wonderful experience with my doctors at Upstate. They became part of my family,” Hannagan said. “Dr. Dubowy, Dr. Kennedy, Dr. Dubanski, Dr. Cherrick and all the nurses and staff made a big impact on my life and I hoped to make that kind of impact on other children and their families.”

Hannagan attended Upstate Medical University, where she also completed her pediatrics residency. She had intended to follow in the footsteps of the doctors that treated her and go into pediatric hematology/oncology, but she found it was too painful.

“I realized that it was very hard for me to emotionally deal with the families,” she said. “I loved everything about it except that; I realized that I couldn’t separate my own experience enough.”

Now, Hannagan is a pediatrician in Chambersburg, Penn. She still keeps in touch with the physicians who treated her here in Syracuse 20 years ago and helped her make the transition from cancer patient to survivor.