Long Term Side Effects of Chemotherapy for Cancer

What Are Possible Late Effects of Chemotherapy?

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The benefits of chemotherapy far outweigh the potential risks, but there are long-term side effects. Many people are familiar with the short-term side effects such as hair loss and nausea, but some side effects may persist or arise months to years after treatment has been completed.

When it comes to long-term side effects, keep in mind that everyone is different. Some people may have several of these side effects, while many will have none. Side effects also vary considerably depending on the particular chemotherapy medications that are used.

Heart Damage

Chemotherapy can cause cardiac effects early in treatment, but in some cases, the effects may not show up until much later.

One notable example is heart damage following treatment with Adriamycin (doxorubicin). With this drug, a possible long-term side effect is weakening of the heart muscle, resulting in heart failure (a decreased ability to pump blood through the body). Symptoms may include increasing shortness of breath, fatigue, and swelling of the feet and ankles. If you have been treated with Adriamycin, your healthcare provider may recommend a MUGA scan to monitor your heart.

Other cancer treatments, such as radiation therapy to the chest area, may cause damage to the heart muscle as well. For example, left-sided radiation for lung cancer or breast cancer may also affect the heart and damage coronary arteries.

If you will be having both chemotherapy and radiation therapy to your chest, your radiation oncologist might suggest respiratory gating, a technique that can reduce the amount of radiation to your heart.

Fatigue

During chemotherapy, most people experience fatigue, and a third of people continue to experience fatigue for months to years after chemotherapy is completed. It is important to discuss this with your healthcare provider—many causes of fatigue are treatable. 

Chemobrain

"Chemobrain," a constellation of symptoms that include problems with memory and concentration, has been recognized as a long-term side effect of chemotherapy. The effects can include symptoms such as problems with short-term memory (losing your car keys), difficulty multi-tasking, and impaired concentration, especially when you are tired.

Coping can involve strategies like doing one thing at a time or slowing down. In most cases, chemobrain symptoms improve over time. 

Infertility

Loss of fertility after chemotherapy is primarily a concern for younger people with cancer. Infertility following treatment varies with the dose and type of chemotherapy medications, and it doesn’t affect everyone.

If you believe you may want to have children after treatment (for both men and women), talk to your healthcare provider about the options available to you before you start treatment. Methods such as preserving sperm, eggs, or embryos have worked for many people.

Peripheral Neuropathy

Neuropathy from chemotherapy often causes a sensation of numbness and burning in the feet and hands, as well as constipation. This is a common side effect after chemotherapy. A history of diabetes, alcoholism, or malnutrition increases the risk. While neuropathy may sometimes improve in time, it can also be a permanent late effect of chemotherapy.

Some drugs that can cause this side effect in up to a third of people include Taxotere (docetaxel) and Taxol (paclitaxel), Other medications, such as Platinol (cisplatin), Oncovin (vincristine), and Novelbine (vinorelbine), can also result in neuropathy.

Hearing Loss

One of the most common long-term side effects of Platinol (cisplatin), a medication used for many cancers including lung cancer, is ototoxicity (damage to the structures of the ear). Other medications may also cause hearing loss and tinnitus (ringing in the ears).

Skeletal Effects

Osteoporosis (thinning of the bones) is the most common late effect of chemotherapy. Most chemotherapy drugs cause accelerated bone loss. Cancer and cancer treatment may also cause changes in diet, which can amplify the problem. The greatest concern over the long run is the risk of fractures due to bone loss.

Chemotherapy has also been associated with osteomalacia, which is bone loss related to a deficiency of vitamin D.

Hormone therapies for women with breast cancer and men with prostate cancer can add to the risk. Many healthcare providers recommend getting a baseline bone density measurement when beginning these therapies.

A class of medications that decrease the reabsorption of minerals from bone (promoting bone stability) called bisphosphonates has been used in early stages of breast cancer in postmenopausal women. These medications are shown to modestly reduce the incidence of bone fractures down the line, and also to decrease the chances of having cancer spread to the bone.

Respiratory Effects

Chemotherapy can cause pulmonary fibrosis (scarring of the lung) and decreased lung capacity in some people. This may be more pronounced when chemotherapy is combined with radiation therapy to the chest area.

Liver Effects

Many chemotherapy medications can cause hepatotoxicity (toxic damage to the liver). The liver has a remarkable potential to regenerate most of the time, as long as other damaging factors (such as excess alcohol intake) are avoided.

Kidney and Bladder Effects

Certain chemotherapy medications, such as cisplatin, can cause damage to the kidneys and bladder. This can result in a decreased ability of your kidneys to filter your blood.

Damage to the bladder can also occur and may be temporary or permanent. Symptoms of bladder irritation may include pain or urgency with urination, or blood in your urine.

Effect on the Eyes

Steroids are often given along with chemotherapy or for symptoms and side effects related to cancer. This can hasten the development of cataracts in some people.

Secondary Cancer

Due to the mechanism by which chemotherapy medications work, they can cause DNA damage in normal cells, which may result in secondary cancers down the line. Some chemotherapy medications are more likely to cause this damage, with a category called alkylating agents being most likely. An example of these is Cytoxan (cyclophosphamide)).

Other medications used to treat lung cancer that may cause secondary cancer include Vepeid (etoposide) and Platinol (cisplatin).

The risk of secondary cancer developing is higher in people who develop cancer at a younger age and with cancers that have a high survival rate. For example, the risk of secondary cancer in survivors of Hodgkin lymphoma is substantial.

Coping With the Late Effects of Chemotherapy

Long-term effects and late effects of cancer treatment are common. Many people find that their "new normal" is not what they would like, and feel frustrated by the symptoms. Cancer survival is improving. It's only very recently that the term "survivorship" was coined, and the long-range physical, emotional, and spiritual aspects of surviving cancer are becoming better understood.

Many of the larger cancer centers now provide cancer rehabilitation to help people maximize their new normal. The STAR program for cancer rehabilitation was designed specifically to address symptoms that prevent cancer survivors from enjoying the quality of life they otherwise can.

What Can You Do to Lower Your Risk of Long-Term Side Effects?

Until we know more about long-term survivorship issues following chemotherapy for adults, there are things you can do:

  • Ask your oncologist about any late effects that you may expect from the particular chemotherapy drugs you were given. Find out when you will need to have the recommended screening tests (for example, tests for heart problems, hearing loss, or osteoporosis).
  • Keep a record of your chemotherapy regimen with you in case you see a healthcare provider who is unfamiliar with your medical history.
  • If you smoke, quit.
  • Make regular appointments with your dentist and eye doctor.
  • Engage in regular physical activity.
  • Limit your intake of alcohol.
  • Let your healthcare provider know if you experience any new symptoms or worsening of current symptoms you have.

For childhood, adolescent, and young adult cancer survivors, long-term follow-up guidelines have been developed to address the long-term side effects and other survivorship issues.

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