Long-term and late effects of treatment

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A small number of children may experience long-term effects, which persist for months or years after treatment, or ‘late’ effects which are problems that do not develop or become apparent until years after treatment ends.

Now that so many children are surviving cancer, there is a large population of childhood cancer survivors and these effects are becoming more apparent.

However, as understanding of the biology of childhood cancers advances and our knowledge about treatment-related problems improves, it is increasingly possible to tailor treatments to meet the needs of individual children – optimising the chance of cure whilst minimising the risk of adverse effects.

The risk of adverse effects varies from child to child, depending on the treatments used, as well as the age of the child at the time of treatment.

Possible effects include:

  • Heart and/or lung complications. These are associated with both radiotherapy and chemotherapy.
  • Impairment of growth. High-dose radiation to the head, spine or whole body is associated with impaired bone and soft tissue growth.
  • Cognitive impairment. This is a particular concern for children being treated for brain tumours and other children receiving radiation to the head and neck. These children may have impaired intellectual ability and may have problems with visual/perceptual skills and learning ability.
  • Infertility. Chemotherapy and radiotherapy (whole body or in proximity to the ovaries or testes) can both impair facility. Egg or sperm banking may be advised for some children.
  • Thyroid problems. Children who receive high-dose chemotherapy to the neck may develop hypothyroidism (deficiency in the production of thyroid hormone).
  • Kidney problems. Some chemotherapy drugs carry a risk of long-term kidney damage.
  • Second cancers. Childhood cancer survivors have a small increased risk of developing another cancer later in life. The risk is greatest in those who have undergone radiotherapy but some chemotherapy drugs also increase risk.

This is not an exhaustive list – the risks depend on a number of factors including the treatments and doses used and the age of the child.

The risks associated with any treatments will be explained in full by the child’s doctor before treatment commences. Every effort will be made to minimise the risk of adverse effects.

All children are followed-up for a number of years after treatment so that any problems can be identified early.

Read more: Side effects of treatment

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