The Late Effects of Treatment for Childhood Cancer
by Galit Rosen, MD, and Robert Goldsby, MD
One of the triumphs of modern medicine is the improved survival of children diagnosed with cancer. As recent as 50 years ago, childhood cancer was almost universally fatal. Now, with advances in medical and supportive care, most children with cancer will reach adulthood and be long-term survivors. There are an estimated 250,000 survivors of childhood cancer in the United States. As this number increases, it is becoming clear that the same cancer therapies (chemotherapy, radiation, and surgery) responsible for improved outcomes can have long-term consequences.
Cancer therapy can damage almost any organ of the body, including the brain, lungs, heart, liver, kidneys, ovaries/testes, and bones. A survivor may have symptoms related to organ injury, such as lung or heart damage causing shortness of breath. Sometimes, early organ damage may not have any external signs and is only detectable by laboratory tests. Other effects are even more subtle, such as difficulty with learning and memory. One of the most serious consequences of cancer therapy is developing another cancer. All these effects can appear months, years, or even decades after completing therapy.
After cancer treatment has ended, many children will go on to lead completely normal lives; others may have persistent symptoms or need to take regular medications to manage long-term problems. It is important that both groups are familiar with their medical history. This can be a challenge for children who were diagnosed very young and have no recollection of their disease or therapy. For these survivors, parents should be open with their children and empower them to take control over their health as they enter adolescence and adulthood.
Cancer therapy can damage almost any organ of the body.
Every survivor should have a primary care physician that he or she sees regularly for annual checkups. This physician should be given written information about the child’s history, including type of cancer, date of diagnosis, specific chemotherapy drugs given, type of radiation and dose, and types and dates of surgeries. Children with the same cancer may be treated in different ways, so it is important to know details of the child’s therapy. This information should be obtained from the treating oncologist. Knowing the survivor’s medical history will help the primary doctor screen for long-term health risks in a customized way. In addition to evaluating the general health of a survivor, the physician can also provide interventions for mental health effects, activity limitations, and cancer- related anxiety.
Dr. Galit Rosen
The risk of developing late effects is related to the type of cancer and the types of treatments received. No two individuals will react the same way to therapy. Routine screening exams and tests are the best way to detect a problem so that interventions can be taken early. In this way, late effects can be minimized. Survivors should tell their physicians about any new symptoms or concerns they have and be proactive with their medical care. Guidelines for long-term follow-up have been established and are available to clinical providers to help facilitate appropriate monitoring of potential late effects.
Lifestyle choices can also affect the risk of long-term effects. To reduce the risk of health problems, quit smoking, eat a high-fiber, low-fat diet, minimize alcohol intake, exercise regularly, and use sunblock. These health-promoting behaviors are important for everyone to follow, especially those who have had cancer.
Survivors of childhood cancer can live active and productive lives, even if they face challenges due to their disease and its therapy. Long-term follow-up improves the health and quality of life for cancer survivors.
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Dr. Galit Rosen is a clinical instructor in pediatric hematology/oncology, and Dr. Robert Goldsby is an associate professor of clinical pediatrics and medical director of the Survivors of Childhood Cancer Program, both at the University of California, San Francisco.
This article was published in Coping® with Cancer magazine, November/December 2007.