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Childhood Cancers: Long-Term Effects of Treatment

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All medical treatments have both benefits and potential harms. This may be more true for cancer treatments than for other medical therapies. Some cancer treatments have side effects even after they have led to a cure. This is especially true for childhood brain cancer and leukemia . Now that childhood cancer survivors are living longer, researchers are beginning to learn more about the possible late side effects of childhood cancer treatments.

Your child’s doctor will make every effort to select treatments that will minimize future risks, as well as discuss what you and your child can expect. This article will acquaint you with some topics that might come up in such a discussion. It is important to keep the possible long-term side effects of cancer treatment in perspective.

Long-term Side Effects of Chemotherapy and Radiation

Many cancers are treated with radiation (high-energy rays that kill or shrink cancer cells) or with chemotherapy , which are drugs designed to kill cancer cells while causing the least harm possible to normal tissues. Two side effects of radiation and chemotherapy that often raise concern are the risk of a second cancer developing at some later time, and the potential risk to a child’s future fertility.

Second Cancers

Children who have been successfully treated for childhood cancer face a small but increased risk of developing a second cancer—of an entirely different kind—during their lifetime. Scientists still don’t completely understand second cancers and they currently have no way of predicting which children are susceptible and which children are not. This risk will likely diminish in the future as doctors use new cancer treatments specifically designed to minimize the development of second cancers.

Fertility Issues

For the Survivor

While most childhood cancer survivors are able to have children, fertility problems can still occur due to cancer treatment. Radiation and chemotherapy affect pregnancy rates more than other treatments. Treatment may lower sperm count in boys, while ova may be affected in girls. Males are more likely to have fertility problems.Your child's age during treatment may also have an effect. For example, boys who have not reached puberty are less likely to be affected by fertility issues than boys who have.

If your child has gone through puberty and is facing cancer treatment, there are ways to preserve fertility in advance. For boys this may include sperm banking, the process of collecting and freezing sperm samples for the future, and organ shielding during radiation treatment. In girls, this may include egg freezing, hormone treatments, organ-saving surgical procedures, and organ shielding. Cancer treatments can also delay puberty in both boys and girls.

Your child's doctor can advise you whether your child’s treatment has a significant chance of affecting fertility. However, if any genetic material from testicular or ovarian tissue is damaged, the risk of abnormalities with your children may be higher.

For the Survivor's Offspring

In general, children born to survivors of childhood cancer are not affected by their parent’s history of cancer treatment.

It is important to discuss options before your child starts treatment.

Side Effects Associated With Brain Cancer

Reducing the complications of treatment for brain cancer, which often involves surgical removal of a tumor followed by radiation therapy to the brain and/or spinal column, remains a serious challenge for children, parents, and doctors. While treatment breakthroughs are anticipated, complications after current treatments of brain cancer are both more frequent and more troublesome than with many other cancers. Be sure to have your child’s doctor explain the kinds of complications that may be expected following treatment for brain cancer and the efforts that will be made to minimize them. Some of the side effects that do occur after treatment for brain cancer include:

  • Changes in behavior and school performance
  • Changes in growth rate and sexual maturation
  • Endocrine problems, which can create hormone imbalances
Neurocognitive Effects

As mentioned above, survivors of brain cancer usually experience trouble with school performance. Children who undergo chemotherapeutic treatment for leukemia may also experience neurocognitive problems. You may notice your child having trouble with learning, paying attention, or keeping up with classmates.

As physicians become more aware of the potential for neurocognitive problems, they are taking steps to identify children who may be affected, and to make sure they receive appropriate educational support. Early identification and support can help your child cope with and overcome these challenges.

In addition, some medical treatment centers are developing techniques to deliver radiation therapy that aim to minimize or even eliminate long-term side effects in children with brain cancer, without compromising the effectiveness of treatment.

Emotional Effects of Cancer and Cancer Treatment

In today’s cancer centers for children, doctors and nurses make efforts to reduce the pain and fear associated with cancer. Despite these efforts, cancer is a frightening disease, and its treatment is rarely without some discomfort. Despite the best medical and nursing care, some survivors of childhood cancer find that memories and anxiety associated with cancer keep sprouting back into their lives, even years after treatment is finished. When fears and memories return frequently and intensely, psychologists may make a diagnosis of post-traumatic stress disorder (PTSD). PTSD does occur in some children who are cured of cancer.

In an effort to help your child from falling victim to PTSD, the oncology staff will likely want to talk with your child about their feelings. Many centers use play therapy so that younger children can express feelings of fear or anxiety. If you find your child continues to worry about cancer or to have disturbing memories or dreams about the treatment process, talk with your doctor about getting psychological help, which may prevent the long-term development of PTSD.

Cancer and Hope

Today, cure is a realistic outcome for many children with cancer, and with more awareness about late effects of treatment, you and your child will be better prepared to handle them if they arise. Even though worrying about future complications is understandable, these concerns should not take precedence over potentially curative treatment decisions. Be sure, however, to ask questions about long-term risks and how they can be minimized. Keep precise records of what treatments your child received and when. And find a doctor that is capable of creating a trusting, long-term relationship with your child. Your child will need to depend on someone other than you when facing the challenges that lie ahead.

RESOURCES:

American Cancer Society
http://www.cancer.org

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

Cancer Care Ontario
http://www.cancercare.on.ca

References:

Childhood cancers (treatment). National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/childhoodcancers. Accessed February 4, 2014.

Children diagnosed with cancer: late effects of cancer treatment. American Cancer Society website. Available at: http://www.cancer.org/Treatment/ChildrenandCancer/WhenYourChildHasCancer/children-diagnosed-with-cancer-late-effects-of-cancer-treatment. Accessed February 4, 2014.

Female delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2013. Accessed February 4, 2014.

Gurney JG, et al. Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors. Cancer. 2003;97:663-673.

Hobbie WL, Stuber M, et al. Symptoms of posttraumatic stress in young adult survivors of childhood cancer. J Clin Oncol. 2000;18:4060-4066.

Late effects of treatment for childhood cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/lateeffects/Patient. Updated January 30, 2014. Accessed February 4, 2014.

Male delayed puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 7, 2012. Accessed February 4, 2014.

Morgan ER, Murphy SB. Care of children who are dying of cancer. [Editorial]. NEJM. 2000;342:347-348.

Rourke MT, Hobbie WL, et al. Posttraumatic stress disorder (PTSD) in young adult survivors of childhood cancer. Pediatr Blood Cancer. 2007;49(2):177-182.



Last reviewed February 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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