Late effects are health problems that occur months or years after treatment has ended.
The cancer itself or the treatment of cancer may cause health problems for childhood cancer survivors months or years after successful treatment has ended. Cancer treatments may harm the body's organs, bones, or tissues and cause health problems later in life. These health problems are called late effects. Treatments that may cause late effects include surgery, chemotherapy, radiation therapy, or stem cell transplant.
Doctors are studying the late effects caused by cancer treatment. They are working to improve 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 are both physical and emotional.
Late effects in childhood cancer survivors may affect the following:
- 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 patient, tumor, and treatment. These include the following:
- Tumor-related factors
Type of cancer.Where the tumor is in the body.How the tumor affects the way tissues and organs work.
- Treatment-related factors
Type of surgery.Chemotherapy type, dose, and schedule.Radiation therapy type, part of the body treated, and dose.Stem cell transplant.Use of two or more types of treatment at the same time.Blood product transfusion.
- Patient-related factorsThe child's gender.
The child’s age at diagnosis and treatment.
Length of time since diagnosis and treatment.
Certain changes in the child's genes.Being exposed to substances in the environment that cause cancer.Family history of cancer or other conditions.Health problems the child had before being diagnosed with cancer.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. However, the number of late effects in childhood cancer survivors increases with longer time since treatment and with older age. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:
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.
- The primary cancer comes back.
- A second (different) primary cancer forms.
- Heart and lung damage.
Regular follow-up care is very important for survivors of childhood cancer.
Regular follow-up by health professionals who are experts in finding and treating 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 type of care will depend on the type of cancer, the type of treatment, genetic factors, and the person's general health and health habits.
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 is familiar with 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 and 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 enjoyed by cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy diet, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of treatment-related health problems. 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, sun exposure, or not being physically active may worsen treatment-related organ damage and possibly increase the risk of second cancers.