Are You Aware of Late and Long-Term Side Effects of Cancer Treatments? 

Many cancer survivors return to normal life after the completion of cancer treatments and can live without any abnormal effects. Only a few will experience late and long-term side effects. Late side effects of cancer treatment arise months to years after cancer treatment is finished. Long-term effects arise after your cancer treatment and persist for a longer time showing undesirable effects. 

Cancer treatments can cause a wide range of physical and psychological effects. Some can fall under late and long-term side effects. It is better to be aware of the late and long-term side effects that you might face after your cancer treatment.

It is crucial to follow up with your primary doctor for consistent checkups even after finishing cancer treatment and stay connected with them. To improve the quality of life and survival rates of cancer patients, follow-up is necessary. This is the time when late effects are monitored and treated as soon as possible.

Types of Cancer Treatments that Cause Late and Long-term Effects:

Almost all cancer treatments cause late and long-term side effects mainly chemotherapy, hormone therapy, radiation therapy, and surgery. But late effects of targeted therapy and immunotherapy are not yet concluded and are under research.

Depending on the type of cancer, its treatment, doses, location that underwent treatment, other medical conditions, and age of the person, different late side effects will occur.  Ask your doctor to know what side effects you might face in the long term based on your treatment.

List of Late and Long-term Side effects from Cancer Treatments:

Treatment type	Late and long-term side effects
Chemotherapy	Dental problems Loss of hearing Early menopause in both men and women Heart problems Lung damage Nerve damage Taste changes Increased risk of secondary cancers Infertility Osteoporosis (thinning and weakening of bones)
Radiation therapy	Early menopause Heart problems Cavities or tooth decay Increased risk of secondary cancers Increased risk of stroke Hypothyroidism Infertility Intestinal problems Lung diseases Lymphedema Memory problems Osteoporosis
Hormone therapy	Blood clots Hot flashes in both men and women Early menopausal symptoms in both men and women Increased risk of secondary cancers Osteoporosis Sexual dysfunction in both men and women
Surgery	Chronic or long-term pain Sexual dysfunction Difficulty with speech or swallowing Memory loss Lymphedema Poor absorption of nutrition Scarring of the surgical site Inability to fight infections

Ways to Prevent Late and Long-term Side effects of Cancer Treatments:

Discuss with your doctor to know possible side effects and what symptoms you should watch for. Follow up with your doctor as scheduled, to check for any signs or symptoms of side effects that may appear later. This can help your doctor to treat them as soon as possible. Please maintain records of your previous treatments and medications to provide to your doctor whenever necessary.

Continuous follow-up is key to managing late and long-term side effects to pave a way for a quality life and increase overall survival. Taking the help of a registered dietician or nutritionist and following a healthy diet and lifestyle can help to some extent. Avoid activities that crush your life such as alcohol, tobacco products, excessive sun exposure, etc.

Various Types of Late and Long-term Side Effects:

Late and long-term side effects can affect more than one part of the body and range from mild to severe. These side effects include;

Fatigue: It is the most common side effect of cancer treatments. It is a feeling of physical or mental tiredness. Some cancer survivors have fatigue for several months to years after completing their cancer treatments. 

Lymphedema: It is the accumulation of lymph fluid that causes swelling and pain in the arms or legs. Patients who have undergone radiation therapy or surgery for the removal of lymph nodes affected by cancer may develop lymphedema. 

Infertility: Patients who had surgeries in the pelvis or abdomen will get fertility issues. They may become impotent to conceive or produce a child either temporarily or permanently. Treatment that focuses on reproductive organs or the endocrine system, increases the risk of infertility in both men and women. 

Cognitive problems: This includes problems with learning, remembering, and concentrating. High doses of chemotherapy and radiation therapy to the head cause problems with remembering things, learning, or paying attention. Symptoms will improve over time. This condition is known as Chemo-brain.

Increased risk of infections: Cancer treatments can weaken the immune system and decrease the body’s ability to fight against infections. Due to this, the patient is easily prone to infections.

Heart problems: If chemotherapy or radiation therapy is given to the chest area, it increases the risk of heart problems in the long term. Cancer survivors of Hodgkin’s lymphoma who received treatment as a child, patients of 65 years or older, patients who received higher doses of chemotherapy and certain medications like trastuzumab, and doxorubicin are at higher risk of getting heart problems.

Here is the list of common heart problems that cancer survivors might experience; 

Congestive heart failure (CHF): This weakens the heart muscles showing symptoms like shortness of breath, dizziness, or swollen hands and legs.

Coronary artery disease (CAD): It occurs most commonly in patients who had received higher doses of radiation therapy to the chest area. This shows symptoms like shortness of breath, and chest pain.

Arrhythmias: This is commonly known as irregular heartbeats showing symptoms like shortness of breath, chest pain, and lightheadedness.

Inform your healthcare team if you are facing any of these symptoms. Ask your doctor if your treatment plan affects the heart. Your doctor will check your heart functions during and after the treatment by Echocardiography. He may also suggest other tests like Electrocardiogram (ECG), and Multigated Acquisition Scan (MUGA).

High blood pressure: It is also called hypertension. Some patients may face accelerated hypertension (sudden fall and rise in blood pressure) which might damage the organs. So it is important to monitor blood pressure during your treatment and get medical help if necessary. Check blood pressure regularly, lose weight if you are overweight, consume less salt, and do regular exercises to reduce the long-term effects of blood pressure.

Lung and kidney problems: These problems come with early symptoms like difficulty breathing, getting tired easily, or dry cough. Patients who have received chemotherapy and radiation therapy to the chest area will develop lung problems in the long run. Late side effects to the lungs include changes in lung functions, thickening of the lining of the lungs, inflammation of the lungs, and difficulty breathing.

Endocrine system problems: Endocrine systems include glands that secrete hormones and organs that produce ovum, or sperms. Some types of cancer treatments affect the endocrine system and cause abnormal hormonal levels and improper functioning of organs that are important to produce eggs or sperms. Radiation therapy to the head and neck area includes the thyroid gland. So, it can also lower hormone levels and change the functioning of the thyroid gland.

Early menopause in women: Cancer treatments like surgery to remove a woman’s ovaries (oophorectomy), chemotherapy, hormone therapy, and radiation therapy to the pelvic area cause women to have menopausal symptoms. These symptoms include changes in mood, lack of sexual desires, osteoporosis, complete or partial absence of menstrual periods if women are not been through menopause yet, hot flashes, and bladder incontinence problems.

Early menopause in men: Some treatments cause hormonal problems in men that are similar to menopause. If men have received hormonal therapy for prostate cancer, or surgery to remove testicles, will face menopausal symptoms. These symptoms include changes in hormonal levels, lack of sexual desires, hot flashes, and osteoporosis (thinning or weakening of the bones).

Bone, joints, and soft tissue problems: Chemotherapy, immunotherapy, hormonal therapy, and steroid medication cause thinning of the bones (osteoporosis), or joint pain. These are known as rheumatologic issues. People who are not physically active may develop a risk of osteoporosis. You can lower your risk of osteoporosis by limiting alcohol intake, avoiding tobacco products, being physically active, and eating calcium and vitamin D-rich foods.

Brain, spinal cord, and nerve problems: Chemotherapy and radiation therapy can cause late and long-term side effects to the brain, spinal cord, and nervous system. These long-term side effects include;

• High doses of chemotherapy cause loss of hearing.
• High doses of radiation therapy to the brain increase the risk of stroke.
• Chemotherapy and radiation therapy can damage nerves resulting in peripheral neuropathy (a condition of numbness, and tingling of hands and feet).

Cancer survivors should follow up with their doctors for physical examinations and hearing tests even after the completion of cancer treatments.

Oral and dental problems: Chemotherapy may affect tooth enamel and increases the risk of long-term dental problems. High doses of radiation to the head and neck area cause changes in tooth development, gum diseases, lower saliva production, dry mouth, and chances of tooth decay. These problems can be managed by frequent intake of water, sugar-free lemon drops to improve saliva, artificial saliva (Biotene-oral rinse) to provide moisture in the mouth, and other medications that will also help.

Vision problems: Steroid medications may increase the risk of eye problems including clouding of the eyes that affects vision, also called cataracts.

Cancer survivors should make an appointment with eye and dental doctors to watch for these side effects even after completing the treatments.

Digestion problems: Chemotherapy, radiation therapy, or surgery may affect the person’s ability to digest food. Radiation therapy or surgery to the abdominal area causes tissue scarring, long-term pain, intestinal problems, malabsorption, diarrhoea, and inflammation of the rectum and anus. 

A registered dietician or nutritionist can help you deal with digestion problems and to absorb sufficient nutrients daily. Along with this, it would be better to consult a gastroenterologist (a doctor who specializes in digestive tract disorders) to help you deal with digestive problems.

Psychological/emotional problems: Cancer survivors often face mental problems like mood swings, fear of recurrence, anger, guilt, depression, anxiety, stress, feeling of loneliness, etc. Try to show some gratitude to be alive, feel some relief, spend time for yourself, try working on hobbies that give you pleasure, join cancer support groups to connect with people in similar situations, or go for counselling if needed.

Secondary cancers: This may be the recurrence of the same cancer after treatment or new primary cancer as a long-term side effect of previous treatment. Secondary cancers often develop from chemotherapy and radiation therapies, or from the same cancer that has spread to other body parts from where it has started.

Note: Not all cancer survivors get all these late effects of cancer treatments. It varies from person to person depending on treatment type, dose, drugs used, the location that has been treated, other conditions, etc. There are some cases where cancer survivors may not get any late or long-term side effects.

For Example: If you don’t receive a drug that affects fertility, or radiation therapy to the abdomen or pelvic area, then you might not face infertility as a long-term side effect.

Questions to ask your healthcare team:

Ask your healthcare team about possible late and long-term side effects that you might experience. We have listed a few questions for you. Consider asking these questions during your visit with your doctor.

• What side effects may I face in the long term?
• Is my treatment regimen supposed to cause late and long-term effects? If so, what are those?
• Am I at risk of developing any specific side effects?
• Are there any possible ways for me to prevent late and long-term side effects?
• What other specialized doctors should I have to consult to identify potential risks early?
• What signs and symptoms should I have to watch for?
• When should I contact you if I experience any symptoms?

Related Topics: 
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