Late consequences (sequelae) of therapy for childhood cancer can be anticipated based on therapeutic exposures, but the magnitude of risk and the manifestations in an individual patient are influenced by numerous factors. Factors to consider in the risk assessment for a given late effect include the following:
Tumour-related factors
- Tumour location
- Direct tissue effects
- Tumour-induced organ dysfunction
- Mechanical effects.
Treatment-related factors
- Radiation therapy: total dose, fraction size, organ or tissue volume, type of machine energy
- Chemotherapy: agent type, dose-intensity, cumulative dose, schedule
- Surgery: technique, site
- Use of combined modality therapy
- Blood product transfusion
- Hematopoietic cell transplantation.
Other related factors
- Gender
- Age at diagnosis
- Time from diagnosis/therapy
- Developmental status
- Genetic predisposition
- Inherent tissue sensitivities and capacity for normal tissue repair
- Pre morbid health state
- Socio-economic status
- Health and lifestyle
- Function of organs not affected by cancer treatment
Long-term and late effects can include the following, but it is important to note that not all patients who have had treatment are at risk.
Physical effects
Related to chemotherapy and other drug therapies
Depending on treatment type, length and individual risk factors, including genetics and overall health, children and adolescents may be at risk of:
- Heart conditions/damage (chronic heart failure, heart muscle injury)
- Thyroid problems
- Lung damage (scarring, inflammation, acute respiratory distress syndrome, lung failure)
- Infertility, including premature ovarian failure and premature menopause in women and low testosterone levels and sperm counts in men
- Osteoporosis (low bone density)
- Hearing loss
- Cataracts
- Secondary cancers
- Peripheral neuropathy, impaired immune system function.
Related to radiation therapy
Radiation therapy uses ionising radiation to kill cancer cells. For this reason, some cancer survivors who have had radiation therapy to the head and neck can develop:
- Hypothyroidism or hyperthyroidism
- Hearing loss
- Vision problems such as cataracts or glaucoma
- Dental abnormalities, such as dry mouth or cavities
- Brain or thyroid cancer
- Osteoporosis (low bone density)
Radiation therapy to the chest can cause:
- Lung damage (scarring, inflammation, breathing difficulties)
- Heart damage (scarring, inflammation, coronary heart disease)
- Osteosarcoma (bone cancer)
- Breast cancer
- Thyroid cancer
- Hypothyroidism or hyperthyroidism
Psychological effects
Children and adolescents may experience long-term psychological effects after treatment ends, including anxiety, depression or post-traumatic stress disorder. Other issues that are relevant post-treatment include:
- Impact of cancer diagnosis and treatment
- Education
- Employment
- Life skills
- Social interaction / peer groups
- Relationships
- Insurance
Further information
Aftercure.org Aftercure is a resource for teenager and young adult survivors of childhood cancer, produced by CCLG. Aftercure comprises a website/online information, a booklet and factsheets with information about specific late effects
Teenage Cancer Trust: After treatment information (for teenagers)
End of treatment publications from CCLG including a booklet for parents, and for teenagers/young people