Late Effects Of Treatment For Childhood Cancer (PDQ®): Treatment - Patient Information [NCI]

General Information About Late Effects

Late effects are health problems that occur months or years after cancer treatment has ended.

Cancer treatments may harm the body's organs, tissues, or bones and cause health problems later in life. They may include physical, mental, and social problems and second cancers. These health problems are called late effects.

Treatments that may cause late effects include:

• surgery
• chemotherapy
• radiation therapy
• stem cell transplant

Doctors are studying the late effects caused by cancer treatment. They are working to improve cancer treatments and stop or lessen late effects. While most late effects are not life-threatening, they may cause serious problems that affect health and quality of life.

Late effects in childhood cancer survivors affect the body and mind.

Late effects in childhood cancer survivors may affect:

• organs, tissues, and body function
• growth and development
• mood, feelings, and actions
• thinking, learning, and memory
• social and psychological adjustment
• risk of second cancers

There are three important factors that affect the risk of late effects.

Many childhood cancer survivors will have late effects. The risk of late effects depends on factors related to the tumor, treatment, and patient. These include:

• Cancer-related factors
  • type of cancer
  • the organs and tissues that were affected by the cancer
• Treatment-related factors
  • type of radiation therapy, part of the body treated, and dose
  • chemotherapy type, dose, and schedule
  • type of surgery
  • stem cell transplant
  • how the use of two or more treatments at the same time affects the body
  • whether transplanted stem cells attack the body's healthy cells, a condition known as chronic graft-versus-host disease
• Patient-related factors
  • the childhood cancer survivor's sex
  • health problems the childhood cancer survivor had before being diagnosed with cancer or developed during or after treatment
  • the age and developmental stage when diagnosed and treated for childhood cancer
  • length of time since diagnosis and treatment
  • changes in hormone levels
  • the ability of healthy tissue affected by cancer treatment to repair itself
  • certain changes in the childhood cancer survivor's genes or a family history of cancer or other conditions
  • socioeconomic status
  • health habits

The chance of having late effects increases over time.

New treatments for childhood cancer have decreased the number of deaths from the primary cancer. Because childhood cancer survivors are living longer, they are having more late effects after cancer treatment. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:

• the primary cancer comes back
• a second (different) primary cancer forms
• heart and lung damage

Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps prevent illness and death from late effects.

Regular follow-up care is very important for survivors of childhood cancer.

Regular follow-up by health professionals who are trained to find and treat late effects is important for the long-term health of childhood cancer survivors. Follow-up care will be different for each person who has been treated for cancer. The care plan the cancer survivor receives will depend on their general health and health habits, the type of cancer, the type of treatment, genetic factors, and other medical conditions. Follow-up care includes checking for symptoms of late effects and health education on how to prevent or lessen late effects.

It is important that childhood cancer survivors have an exam at least once a year. The exams should be done by a health professional who knows the survivor's risk for late effects and can recognize the early signs of late effects. Blood and imaging tests may also be done.

Long-term follow-up may improve the health and quality of life for cancer survivors. It also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children may be developed.

Good health habits are also important for survivors of childhood cancer.

The quality of life for cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy diet, exercise, and regular medical and dental check-ups. These self-care behaviors are especially important for cancer survivors because of their risk of health problems related to treatment. Healthy behaviors may make late effects less severe and lower the risk of other diseases.

Avoiding behaviors that are damaging to health is also important. Smoking, excess alcohol use, illegal drug use, not following good sun protection measures, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers.