Completing childhood cancer treatment is a huge relief for a family. But is the treatment really something you can leave completely in the past? Not always. Some childhood cancer survivors develop health problems months, years, or even decades after treatment. These are known as late effects. They can affect different parts of the body, and a survivor may have no symptoms for a long time before a problem becomes noticeable. The risk isn't the same for everyone. It depends on the type of cancer, age at treatment, and the treatments received.
What are possible causes of late effects?
Sometimes, cancer or chemotherapy damages healthy tissues as well as cancer cells. Long-term health issues could be caused by radiation, chemotherapy, corticosteroids, and stem cell transplants. The timing may also be unpredictable. For example, abdominal radiation received during childhood may affect the pancreas and contribute to diabetes many years later. One of the reasons survivors should share their childhood cancer history with their doctors, even if they are feeling normal today, is because of this long lag.
Diabetes and childhood cancer survivorship
Some survivors are more likely to get diabetes following treatment. It may increase after abdominal radiation and after receiving total body irradiation or high doses of the medication cortisone. The treatment can have an impact on either the pancreas or the hormones that regulate blood sugar. Having a family history of type 2 diabetes can make it even more likely.
Doctors may want to monitor fasting blood glucose or HbA1c on a regular basis, depending on the extent of the treatment history of a survivor. Some individuals who have received stem cell transplantation might also require a glucose tolerance test in the future, especially if diabetes is suspected.
Metabolic syndrome and heart health
Metabolic syndrome is another problem that doctors look for. It is a combination of issues like excess weight, hypertension, hyperglycemia, and an imbalance in blood cholesterol.
These changes, over time, increase the risk of type 2 diabetes and cardiovascular disease. This risk might be influenced by previous radiation exposure to the whole body, brain, abdomen, or chest. Some physical inactivity, smoking, diet, and hormonal changes can also be contributing factors. Blood pressure, weight, blood sugar, and cholesterol should all be checked regularly,y as this can help detect these issues early.
So what are the options for survivors?
Treatment received by the survivor should be the basis for follow-up care. The Children's Oncology Group (COG) Long-Term Follow-Up Guidelines employ this risk-based system to assist decision-making about health monitoring. So too are lifestyle factors. Engaging in regular exercise, eating a good, balanced diet, abstaining from cigarettes, and keeping your weight under control can help keep your heart and metabolism in check. Survivors also should maintain documentation of their prior cancer care, if possible. This information may prove helpful during the transition from paediatric to adult health care or when meeting a new health care provider.
Why long-term follow-up is important
Someone may achieve a normal life after cancer and experience no consequences of their treatment, but have an increased risk of developing some health problems later in life as a result of earlier treatment. This does not imply that health care providers should lead lives afraid of having late effects. It means that their medical history should be taken into account. Regular screening and healthy habits might give childhood cancer survivors an earlier chance to notice issues and to care for their health more as they get older.