Long-Term Side Effects of Chemotherapy
As treatment methods for cancer advance, we see enhanced rates of recovery and cure among cancer patients. This progress is especially evident in children, with more of them becoming cancer survivors. However, the journey of cancer survivorship comes with its own set of challenges due to the various side effects of treatment. While some side effects manifest during treatment, others, known as late effects, may surface years later.
Late Effects of Cancer Therapy on Various Organs
Heart-related problems: The use of chemotherapy agents poses a potential risk to heart health, elevating the chances of coronary artery disease, stroke, and heart failure. Patients treated with anthracyclines and those undergoing chest radiation therapy face an increased likelihood of developing heart disease later on. Congestive heart failure, characterized by a weakened heart muscle, may present symptoms such as shortness of breath, dizziness, and swollen extremities. Additionally, individuals with a history of high-dose chest radiation therapy are more susceptible to coronary artery disease, exhibiting symptoms such as chest pain and shortness of breath.
Lung problems: The lungs may suffer damage from various medications and chest radiation, leading to limitations in lung capacity. Common symptoms include wheezing, coughing, and breathing difficulties.
Hormone production: Irradiation of the chest or neck can reduce thyroid hormone production, while radiation to the head may result in decreased pituitary gland function, leading to issues such as growth retardation and delayed puberty.
Hearing impairment: Pediatric cancer patients frequently undergo treatments like cisplatin, known to potentially affect hearing. Children under the age of 5 are particularly vulnerable to experiencing hearing loss as a side effect of these medications.
Infertility: Chemotherapy agents, such as cyclophosphamide, have the potential to harm reproductive organs. Brain radiation can lead to reduced hormone levels in both males and females and direct radiation to the abdomen or genitals can further damage reproductive organs. These issues may result in low hormone levels and even permanent infertility in both genders. Before such treatments, it may be feasible to preserve eggs or sperm from the patient, offering the possibility of conception in the future.
Brain, spinal cord, and nerve-related problems: Pediatric cancer patients undergoing intensive brain radiation face an elevated risk of stroke. Both chemotherapy and high-dose radiation therapy directed at the head can result in cognitive issues for both adults and children. The developing brains of younger children make them particularly susceptible to cognitive problems, which can manifest as difficulties in processing information, low IQ, poor attention, concentration issues, and impaired memory. Due to these concerns, the use of radiation is generally avoided in very young children.
Several chemotherapy agents and spinal radiation have the potential to harm the nerves outside the brain and spinal cord, known as peripheral neuropathy. This may result in symptoms such as tingling, numbness, and diminished motor skills in the hands and legs. Additionally, nerve damage can lead to urinary retention or issues with urinary and bowel control, causing incontinence.
Kidney problems: Most chemotherapy agents are eliminated from the body through the kidneys, with many of them posing a risk of kidney damage. In some cases, children may have tumors directly affecting the kidneys, and the removal of one kidney can increase the vulnerability of the remaining kidney. Additionally, abdominal radiation has the potential to be detrimental to kidney health.
Bone, joint, and soft tissue problems: Surgical procedures for bone or soft tissue cancers may result in the loss of an entire limb or part of it, posing significant physical and mental challenges for individuals.
Treatments such as chemotherapy, steroid medications, and hormonal therapy can lead to bone thinning (osteoporosis) or joint pain. Immunotherapy may also present challenges in the joints or muscles. Individuals with a sedentary lifestyle may face an increased risk of developing these conditions.
Lowering the Risk of Osteoporosis
To reduce the risk of osteoporosis, cancer survivors can take the following steps:
1. Abstaining from tobacco products
2. Consuming foods high in calcium and vitamin D
3. Engaging in regular physical activity
4. Moderating alcohol consumption.
