Beyond Survival, Childhood Cancer Survivors Rewrite The Parenthood Story

For many families, hearing the words "your child has cancer" feels like watching the future collapse in an instant.

The immediate concern is survival. Questions about education, careers, marriage and parenthood seem distant when a child is fighting for life. Yet for a growing number of childhood cancer survivors, questions like "Will I be able to get married? Will I ever have children?” eventually returns — often years after treatment has ended.

A new study from Mumbai's Tata Memorial Hospital (TMH), Mumbai, has offered a fresh insight into how childhood cancer survivors navigate these milestones. Its findings suggest that the biggest barriers to marriage and parenthood may not be medical at all. Instead, employment, social acceptance and economic stability appear to play a far greater role in shaping life after cancer.

The retrospective cohort study, titled Predictors of Marriage and Parenthood in Adult Survivors of Childhood Cancer: An Indian Perspective, analysed 844 survivors above the age of 25.

Conducted by Dr. Maya Prasad, Dr. Venkata Ramamohan Gollamudi and Dr. Savita Goswami from the Division of Paediatric Oncology, Tata Memorial Centre, Mumbai, and Homi Bhabha National Institute (HBNI), the study examined marital status, parenthood and factors influencing these outcomes.

The findings reveal that marriage rates among survivors remain relatively modest. Only 36.4 per cent of male survivors and 37.6 per cent of female survivors had ever married.

Certain groups faced greater challenges. Men were significantly less likely to marry than women, while survivors of central nervous system tumours and retinoblastoma had lower odds of marriage compared with survivors of other childhood cancers.

What stood out most, however, was the influence of employment.

Survivors who were employed were nearly four times more likely to be married than those who were unemployed. The finding highlights the importance of financial independence, social participation and economic security in determining life opportunities, even among those who have successfully overcome a life-threatening illness.

The study also examined parenthood among married survivors. Researchers found that those treated before the year 2000 were more likely to have children than survivors treated in later years. The reasons may reflect changing social trends, including delayed marriages, evolving family preferences and shifting reproductive choices among younger generations.

Perhaps the most reassuring finding was that most treatment-related factors were not significantly associated with whether survivors eventually became parents.

For families confronting childhood cancer, fertility often becomes a source of anxiety. Chemotherapy, radiotherapy and certain surgeries can affect reproductive function. Yet the study suggests that parenthood remains achievable for many survivors.

Researchers did find that individuals who had received highly gonadotoxic therapies — treatments known to damage reproductive organs — were more likely to rely on assisted reproductive technologies (ART). Even then, advances in fertility care are helping many survivors fulfil their hopes of starting families, noted the study.

According to Dr. Megha Saroha, Paediatric Oncologist and Hemato-Oncologist at Dharamshila Cancer Hospital, Delhi, survivorship concerns extend well beyond medical recovery.

"The current scenario has improved, though still evolving, and patients, before starting treatment, undergo fertility counselling and possible ways they can try and preserve their eggs/sperm/ovarian/testicular tissue and also use techniques which are sparing the ovaries/testes. But many a time the presenting condition and cancer are severe enough to start treatment right away, leaving no time for discussion about fertility preservation. And there are other issues, including logistics, affordability, etc., which act as a barrier," she said.

Dr. Saroha noted that many survivors are able to lead normal lives, marry and have children, although concerns about employment, relationships and parenthood remain common.

Today, more than 80 per cent of children diagnosed with cancer survive into adulthood.

Dr. Adhip Arora, Medical Oncologist at AIIMS Delhi, said the conversation around survivorship has evolved considerably over the years.

"Most childhood cancer survivors are able to have children; approximately 10–25% may experience long-term fertility impairment, with the risk being highest among those exposed to intensive chemotherapy, radiation involving the reproductive organs, or stem cell transplantation."

"Also, advances in fertility preservation and reproductive medicine mean that parenthood remains an achievable goal for many survivors," he said.

Scientific evidence increasingly supports these views.

Yet another study published in the Journal of the National Cancer Institute in 2022 found that women who survived childhood cancer were just as likely as other women to have healthy babies, with no increased risk of birth defects or major neonatal complications.

The study did identify a higher risk of certain pregnancy-related complications among survivors, underscoring the need for specialised monitoring and personalised obstetric care. But the overall message was encouraging: childhood cancer does not automatically close the door to parenthood.

Dr. Shuchi Rastogi, Gynaecologist and IVF expert and Director, Follicles IVF and Fertility Clinic, Noida, felt awareness and timely planning are crucial.

"Many cancer survivors can go on to become parents with the right guidance and timely fertility planning. This is especially important for adolescents, young adults, and reproductive-age women and men diagnosed with cancer."

"Your cancer story does not have to end your dream of parenthood. Survival is the first victory — creating the life you dreamed of can be the next."

Experts say these findings reinforce the need to expand survivorship care beyond disease monitoring.

Vivek Sharma, founder of UHAPO, which works in the cancer ecosystem through awareness, patient navigation, and community support, argued that India must now focus on life after cure.

"Childhood cancer is devastating anywhere in the world, but in India, it often becomes more than a medical crisis. It becomes a social, emotional, and family crisis," he said.

"India now needs to look beyond a cure. Childhood cancer care must include survivorship counselling, school re-entry, fertility counselling, mental-health support, skill-building, job placement and social reintegration. A child should not just survive cancer. They should be helped to return to life with dignity."

That shift in perspective may be the most important development of all in the childhood cancer landscape.