Long-Term and Late Effects of Treatment in Cancer Survivors
Natalie Dickson M.D., CMO Tennessee Oncology
There are over 14 million cancer survivors in the U.S. and close to 30 million worldwide. The numbers are expected to rise due to improvements in cancer screenings, as well as the development of more effective therapies. However, cancer survivors are at risk for a wide range of long-term and late effects of treatment. The earlier identification of long-term and late effects could reduce the severity of symptoms, improve function and performance and maybe improve survival. Therefore, it is important for patients and physicians to be aware of long-term and late effects of treatment.
The reported long-term effects for chemotherapy include the following: cardiomyopathy/heart failure (adriamycin and herceptin), neuropathy/nerve damage (taxol, cisplatin and vincristine), premature menopause, sexual dysfunction, infertility (alkylating agents), depression, anxiety, sleeping problems, fatigue, osteoporosis (hormonal therapy and steroids), pain and myelodysplasia (alkylating agents). In addition, chemotherapy increases the risk of second malignancies, such as leukemia (topoisomerase inhibitors and alkylating agents) that can occur 2-7 years later and solid tumors (alkylating agents) in the lung, gastrointestinal and/or bladder areas.
Radiation therapy, depending on the dose and field of treatment, may result in long-term effects, including coronary artery disease, pulmonary fibrosis, cognitive impairment/memory loss, brachial plexopathy or other nerve damage, pain, lymphedema, strictures, proctitis, myelodysplasia, infertility, hypothyroidism and cataracts. Radiation-induced second malignancies, such as sarcomas and myelodysplasia, tend to occur 5-10 years after treatment.
Patients treated for Hodgkin’s disease, non-Hodgkin’s lymphoma and head and neck cancers are at the highest risk of second malignancies. Patients with inherited mutations, such as p53 and retinoblastoma, are also at high risk of treatment-related second malignancies.
Aside from clinical long-term and late effects of treatment, a significant socioeconomic burden is also present due to high annual medical costs, increased number of missed work days and potential lack of eligibility for life, disability and long-term care insurance.
Tennessee Oncology physicians are experienced in addressing long-term and late complications. We are mindful of both the clinical and socioeconomic issues surrounding our patients’ cancer care. Our practice provides patients with a palliative care physician and nurse practitioners for symptom management and psychologists for counseling, as well as patient care coordinators and financial counselors to support patients and allow them to live to their full potential. We strive to work closely with our primary care colleagues to ensure our patients’ needs are met. Caring for cancer patients is a privilege.