After Wilms Tumor Treatment, First Grade is First Rate for Pediatric Cancer Survivor

The last two school years will be remembered for the tremendous challenges they presented students due to COVID-19, but rising second-grader Caroline McMahan and her family were ready for the pandemic’s limitations after what they had already endured.

By the time the pandemic began, Caroline, 7, was already adept at washing up, masking up, and keeping up with friends remotely because of her prior experience undergoing treatment for a stage IV Wilms tumor in the Solid Tumor Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Patients with Wilms tumor, the most common type of kidney (renal) cancer in children, have severely compromised immune systems for much of their treatment and recovery. This makes them more susceptible to a variety of infections.

Despite these obstacles, Caroline has persevered with the support of her care team, family, and friends.

“Dana-Farber/Boston Children’s is a truly amazing place,” says Katie McMahan, Caroline’s mom. “Not only did they save our little girl’s life, but they gave her so many priceless life experiences while she was there so she didn’t feel like she was missing out on her ‘normal life’ while in treatment.”

And, when asked her feelings about her journey, Caroline will always proudly say, “Yeah, I kicked cancer’s butt!”

Caroline McMahan.

Pioneering approaches

The first sign that atypical days lay ahead for the McMahans came in September 2018, during a trip to visit family in Wisconsin. Caroline was six at the time.

“We were on a plane and she ran down the aisle, as little kids will do. When Nate went to grab her he felt a bump on her abdomen,” recalls Katie McMahan.

After the couple got home, they took Caroline to the pediatrician, who immediately sent the girl and her parents to Boston Children’s Hospital. A swollen abdomen is one of the most recognizable signs of Wilms tumor, which turned out to be Caroline’s diagnosis.

Like most parents of children receiving a Wilms diagnosis, Katie had never heard of this cancer, which is diagnosed in approximately 500 children annually in the United States. Caroline had stage IV disease that had spread into her lungs; she would need surgery to remove the kidney tumor, followed by radiation and chemotherapy.

Wilms tumor specialists in the Solid Tumor Center at Dana-Farber/Boston Children’s have pioneered important new surgical and medical approaches to the treatment of Wilms, and participate in large cooperative studies through the National Wilms Tumor Study Group and Children’s Oncology Group to find the most effective and safest treatments.

“Our team of pediatric oncologists, radiation oncologists, and surgeons have extensive experience treating children with Wilms tumor, including those with complicated or advanced-stage disease, like Caroline,” says Lara Wahlster, MD, PhD, a Hematology/Oncology fellow at Dana-Farber/Boston Children’s who oversaw Caroline’s care along with Elizabeth Mullen, MD. FAAP, program leader in Renal/Liver Tumors. “In collaboration with the Children’s Oncology Group, our Kidney Tumor Program oversees clinical research designed to improve understanding and treatment of childhood kidney tumors.”   

Says Katie McMahan: “We are so thankful that Caroline could be treated by the best doctors in the world, essentially in our backyard.”

Two years and running

Through 31 weeks of treatment, which took place both at Boston Children’s Hospital and Dana-Farber’s Jimmy Fund Clinic, the entire McMahan family received tremendous support from the doctors, nurses, and support staff. Caroline’s second year of preschool was disrupted, but child-life specialists in the Jimmy Fund Clinic focused on cheering up their patient.

“They gave us lots of fun things to do, including the chance to walk on the field at Fenway Park with other patient families and celebrate pediatric cancer survivorship month on September 7, 2019,” Katie McMahan recalls.

Caroline and her father Nate during the virtual Boston Marathon in 2020.

That was the first anniversary of Caroline’s diagnosis; on the second, September 7, 2020, the family watched Nate run 26.2 miles on a rail trail in Holliston as part of a virtual Boston Marathon held to raise funds for research and patient care through the Dana-Farber Marathon Challenge (DFMC). Caroline even biked alongside her dad for six miles.

Caroline was already done with active treatment by then, and only being seen at Dana-Farber/Boston Children’s for checkups. The virtual marathon was one of many COVID-related restrictions that she and her parents took in stride. They had been there before.

“We knew what it was like to have someone you love living without a healthy immune system,” says Nate McMahan. “It’s wonderful to see all the kids getting back to their normal lives.”

Now cancer-free for two years, Caroline is excited to watch Nate run the real Boston Marathon — which he will do with the DFMC team on Oct. 11. She won’t get to accompany him by bike this time, but Nate says Caroline will still always be on his mind.

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