"I have three patients right now ... all of them have second cancers," she said. "Not one of them has said to me, 'I don't want treatment.' They feel like they beat it once, they can beat it again.
"They have so much more to live for now."
Krauel added, though, that she hopes researchers "will be able to do more research on pediatric chemotherapy and radiation so other childhood cancer survivors don't have to experience so many late effects and are able to live a more normal life.
"When they ask me how I do it, I just tell them that I keep my head up and keep putting one foot ahead of the other."
In 1993, doctors presented Kathy Riley of Granada Hills, Calif., with what some might call an impossibly difficult choice. Her son, Peter, had been diagnosed at the age of 5 with a malignant brain tumor. He could have the treatment that could save his life -- surgery, whole-brain radiation and a nine-month course of chemotherapy.
But along with this treatment came the very real likelihood that his intellectual development would be forever altered by the treatment.
"Sort of the dark side of cancer is that you are not given any good choices," said Kathy Riley said. "Peter was a brilliant little 5-year-old with a great future ahead of him. We knew the effect the radiation could have on his developing brain.
"It was the choice of a different life than we had imagined versus most certainly death."
The Rileys opted for the life-saving treatment, and as feared, the radiation to Peter's brain had the effect of permanently impairing his mental function.
"Intellectually he is not the same child that he would have been," Kathy Riley said. "Some of the higher level reasoning and critical thinking skills, he just doesn't have that."
But this side effect was not the only detrimental effect from treatment that Peter would experience. About 10 years after the radiation treatments, he developed a second brain tumor that was likely a result of the irradiation.
"It was the same kind of tumor that they saw years later after the bombings of Hiroshima and Nagasaki -- it was essentially radiation poisoning," Kathy Riley said.
Fortunately, this tumor was benign and could be removed through surgery. But Riley said that hearing from a doctor that her son would possibly have a second experience with cancer was a major blow.
"It was heavy. It wasn't devastating; the first time you go through it, it is completely devastating because it is so frightening," she said. "It was almost as if he was paying a price we didn't want him to for a cancer."
Shad said that for parents like Kathy Riley, the realization that life-saving treatment often comes part and parcel with significant side effects is a grim one.
"I think it takes a while to sink in," she said. "They are usually very upset about it ... but those that realize that there are these side effects also feel like they don't have a choice. It's an awful place for parents."
Peter is now in remission from cancer. He has to have MRI scans for the rest of his life; the type of tumor that most recently occurred in his brain, though benign, is known to recur. Peter also has some hearing loss, and his thyroid must be monitored for unusual growths. His treatment has affected his ability to find employment, and he may never live on his own.