Understanding the Late Effects of Cancer and Its Treatment
More people are surviving cancer than ever before. According to the American Cancer Society, more than 15.5 million Americans have a history of cancer survival. Many of them are survivors of childhood cancers. Over half of the people diagnosed with cancer are alive 5 years later. Many of them are cured. As more and more people survive longer, we are seeing new problems develop from the cancer or its treatment. These problems are called late effects.
What causes late effects?
Healthcare providers are trying to figure out why people have late effects, who might be more at risk for getting them, and what can be done to prevent or manage them. Late effects may include physical problems, psychological effects, a second cancer, and other problems. Late effects can depend on:
The type of cancer you had
How old you were when you were diagnosed and treated
The type of treatment you received
Having cancer does not mean that you will definitely have late effects. But you should ask your healthcare team about your risks of getting late effects, what you can do to prevent them, and how to manage them.
Physical problems often depend on the type of treatment or cancer that a person had. Any part or function of the body can be affected. Some people develop problems with their bones, muscles, hearing, breathing, stomach, kidneys, bladder, blood, and bone marrow. Other people may have hormonal problems, causing growth and puberty problems in children and premature menopause, infertility, and sexual problems in adults. Some people have only one problem while others may have more than one. It is not known why this happens to some people and not to others.
Here is a short list of some treatments and common late effects. Please remember that this list is not complete. Discuss your case with your healthcare provider:
Radiation. The late effects of radiation depend on what part of the body was treated and how much radiation was given. For example, if the head was treated with radiation, possible late effects can include cataracts and dental problems. If the abdomen or pelvic area was treated, bowel or bladder problems could develop.
Surgery. The late effects of surgery also depend on what part of the body was operated on and what was done. If you have lymph node surgery, then you may develop swelling of the arm or leg (lymphedema). If you had abdominal surgery, scar tissue can sometimes cause bowel problems.
Chemotherapy. Chemotherapy late effects depend on the type and amount of medicines given. Some medicines can cause heart damage. Others can affect nerves or cause lung tissue damage or memory problems.
Learning disabilities. Some cancers and their treatments can cause learning problems. These can affect how someone learns and remembers things. For example, many people who are treated for brain tumors often need cognitive rehabilitation to train them how to remember and learn things. Researchers are also studying a phenomenon called chemo-brain. This happens when attention, memory, and other thinking functions are affected after someone has chemotherapy.
Emotional problems. Worrying about the cancer returning or having tests is a normal fear. But when the worry or fear takes over your life, you may need help. Depression and post-traumatic stress disorder are 2 possible effects of the cancer and its treatment. You may also be depressed because of problems caused by late effects. For example, if your cancer or treatment caused you to be infertile or sterile, then you may be depressed about your inability to have children.
Depression is a serious illness. If you are depressed, you may:
Focus on the bad things
Not enjoy life
Feel that life is not worth living
Feel that you are a burden
Feel that you don't deserve any help
Not have energy
Stay away from friends and family
Some cancer survivors develop post-traumatic stress disorder. This means that they are having a hard time adjusting to having cancer or to surviving cancer. If you have post-traumatic stress disorder, you may:
Have dreams or flashbacks about your cancer or treatment
Feel very scared, angry, or upset if you are reminded of your illness or treatment
Not remember things
Stay away from your loved ones and friends
Have trouble sleeping
Have trouble concentrating
If you think that you have depression or post-traumatic stress disorder, it's important to talk about how you feel. You may need to learn new ways to cope with your feelings and how to relax. Your healthcare team may be able to recommend a counselor for you to talk to or prescribe an antidepressant.
Developing a second cancer is not common, but it can happen. You could get a second cancer from the treatment you got to cure your first cancer. In some cases, more cancer screening may be recommended. Also, cancer runs in some families who may be more likely to get more than one cancer. If you do things that would increase your risk of getting cancer, such as smoking, you could also get another cancer. You can ask your healthcare provider what cancers you might be at higher risk for and what you can do to either reduce your risk for them or find them early.
It's important to talk to your healthcare provider about late effects. He or she can tell you which problems you could be at risk for, what you can do to prevent them, and how to manage them if they occur. Remember that many cancer survivors don't develop any late effects. See your provider regularly for a checkup. Ask if there are programs and support groups for cancer survivors and their families. And, remember that if you feel worried or depressed or are having a hard time coping, you should talk to a mental health provider. This might be a licensed clinical social worker, a clinical psychologist, or a psychiatrist.
Living with cancer is hard. Sometimes surviving it can be hard, too. There is help.
June 15, 2018
LoCicero, Richard, MD,Sather, Rita, RN