Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version

General Information about Late Effects

KEY POINTS

Late effects are health problems that occur months or years after treatment has ended.
Late effects in childhood cancer survivors affect the body and mind.
There are three important factors that affect the risk of late effects.
The chance of having late effects increases over time.
Regular follow-up care is very important for survivors of childhood cancer.
Good health habits are also important for survivors of childhood cancer.

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

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, tissues, or bones and cause health problems later in life. These health problems are called late effects.

Treatments that may cause late effects include the following:

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 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 tumor, treatment, and patient. 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.
- Type of radiation therapy, 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.
- Chronic graft-versus-host disease.
Patient-related factors
- The child's sex.
- Health problems the child had before being diagnosed with cancer.
- The child’s age and developmental stage when diagnosed and treated.
- 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 child's genes.
- Family history of cancer or other conditions.
- 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 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. Follow-up care includes checking for signs and 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 checkups. 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, being exposed to sunlight, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers.