Steve and Candice Ward must be vigilant about helping their toddler Jake, a cancer survivor, avoid illness. The Wards don't leave home without antibacterial wipes and have posted handwashing reminders on their front door.

Cancer treatment left Jake, 2, vulnerable. His safety depends on others being vaccinated

Candice Ward would have given anything to cuddle her infant son or soothe him with a lullaby. But all she could do was watch from a monitor in the next room.

Seven-month-old Jake lay face up, strapped to a cot. His head was secured in a mesh headpiece that looked like a goalie mask. A radiation therapist had marked targets on it for the cancer-killing beams that would aim at the tumours behind his eyes.

And right in the middle, someone had cut a tiny opening at his mouth, just enough room for his soother to poke through.

Candice and Steve Ward watched the soother bobbing up and down as their baby sucked and dozed amid the whir of the radiation machine and fans.

Until that day in November, 2012, Jake’s life had been so textbook it could have been plucked from the pages of What to Expect: The First Year.

He smiled early and often. He cooed, sat up and rolled over in line with developmental charts. He breastfed with gusto and was a good sleeper.

Just after Halloween, his parents noticed his right eye was a little red. At a routine medical checkup, the doctor detected something pushing it up. Suddenly the Wards found themselves in a blur of referrals, examinations and CT scans, as both eyes gradually turned black and blue.

Two weeks later, doctors at Sick Kids Hospital diagnosed neuroblastoma, a rare childhood cancer that occurs in nerve tissue. It had started in Jake’s left adrenal gland and spread from his abdomen to his head, forming two cone-shaped tumours behind his eyes. Treatment started that day.

Over the next year, he had 17 radiation sessions and eight rounds of high-dose chemotherapy. There was surgery to remove Jake’s abdominal tumour. He later lost his left kidney as a result of complications.

While Jake cut his baby teeth, doctors harvested stem cells through a stent in his upper leg for the transplant that came a few months later, putting him in isolation for 32 days.

“It was a whirlwind,” says Candice, 31. She took time off from her job as an urban planner while Steve, 46, commuted from work as an electrician in Markham to Sick Kids at night.

“I became project manager of my son’s health,” says Candice. She calmed him as he was poked for blood and hooked to intravenous lines, sang him to sleep before scans, pumped and breastfed between treatments.


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Jake’s tumours are gone. He’s the size of a healthy 2-year-old and races around the living room swinging mini-sticks and pushing his trucks. This summer, finally free of his port, tubes and dressings, he got to splash in the lake at the family cottage. In September, he started nursery school three mornings a week.

But the treatment that saved his life also makes Jake vulnerable. Along with killing the cancer cells, it wiped out his immune system. All the antibodies he had built up in infancy and through three sets of standard immunizations were obliterated, leaving him as susceptible to infection as a newborn.

Not only is he more at risk of catching contagious diseases like chicken pox or measles, once infected, his body would be less able to cope and the diseases could be life-threatening.

Kids with compromised immune systems also can’t be vaccinated. Doctors typically wait at least a year after cancer treatment ends before beginning to re-immunize young patients, starting with their baby shots.

The Wards must be vigilant. They don’t leave home without antibacterial wipes. They’ve posted handwashing reminders at their front door. Before their 9-year-old nephew visits, his parents check with his school about whether he could have been exposed to illness.



The park around the corner is not just a favourite destination, it’s a necessity. Playing in the open air is safer for Jake than going to an indoor moms-and-tots group or visiting a houseful of kids.

On an autumn afternoon, Jake trots along the path between his mom and dad, clutching their hands. He stops and braces himself, waiting for them to raise their arms and swing him through the air as they walk.

He tilts his head back, crinkles his brown eyes and lets out a hiccupy giggle, the kind that makes passersby grin. “More!” he shouts.

Candice is always on the lookout. The children at Jake’s licensed nursery school must be up-to-date with mandatory shots, she explains as Steve hoists their son to his shoulders.

That’s Jake’s best protection because it means minimal risk of an outbreak that could make him very sick.

But there’s no way to know the status of others in the community. Candice is friends with a co-worker who doesn’t believe in the varicella (chicken pox) vaccine. They don’t get together anymore.

As the parent who depends on others being vaccinated to protect her child from exposure, she’s frustrated at the lack of accurate information about immunization rates. She wonders how, at a time when the whole world is online, there is no electronic registry to keep track and it’s up to parents to update public health about the status of their school-age kids.

“It’s an honour system,” she says. “That’s scary, especially in a day and age when we have an app for everything.”

One morning about two weeks after that autumn walk, Candice noticed three spots on Jake’s belly. She wondered if it was heat rash, or if he’d scratched himself. By bath time, he was covered, so she emailed photos to his doctors.

And the following afternoon he was admitted to Sick Kids again. After almost two years in the shadow of cancer and just as he was settling into a normal routine, Jake was back in hospital, this time in isolation for chicken pox.

“We were devastated when we heard those words. We were afraid of how lethal it could be,” says Candice.

Chicken pox is itchy and miserable for a typical healthy child. But for those with compromised immunized systems, it can be much more serious. The virus carried in the bloodstream can cause inflammation of vital organs. There is higher than normal risk of secondary infection in the sores.

The Sick Kids team decided to treat Jake’s case aggressively. Three times a day, nurses in masks, robes and gloves administered the antiviral medication acyclovir through an intravenous line.

One potential side effect of the drug is kidney damage, which was worrying because Jake only has one functioning kidney. That meant pumping him with IV saline to flush out his system and blood tests twice a day to monitor kidney function.

Even though he’s only 2, Jake is a pro at swallowing pills, which came as a blessing. After five days in hospital, he was allowed to go home with instructions to continue the drug in tablet form.

No one knows for sure how the little boy was exposed. The incubation period suggests it may have been at a hospital clinic. The varicella vaccine is much newer than those for measles or rubella, so the disease is still much more prevalent.

But that won’t stop Candice and Steve from watching and worrying.

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