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Even though most cases of childhood acute lymphoblastic leukemia (ALL) are cured, your child should visit his or her pediatrician or doctor at least once a year for a complete physical exam and any additional needed tests. Survivors don't necessarily need a cancer specialist for routine checkups and screening, but they do need to see doctors who understand their previous treatment and its risks. Coordination between your child's cancer specialists and pediatrician is essential to provide the best care.

Regular doctor visits are encouraged to:

  • enable doctors to assess the full effect of therapy
  • detect and treat disease recurrence
  • identify and manage long-term and late effects of treatment

Your pediatrician should recommend a schedule for having your child's learning skills assessed. If your child appears to be experiencing learning disabilities, special education methods can help.

Coordination between your child's pediatrician and oncologist is important for the best care possible. Some treatment centers offer comprehensive follow-up care clinics for childhood cancer survivors. To find one near you, visit The Pediatric Oncology Resource Center.

Long-Term and Late Effects of Treatment

Some side effects of cancer treatment, such as fatigue, can linger for months or years after therapy. Some medical conditions like heart disease and other cancers may not appear until years after treatment ends.

Most childhood survivors of leukemia don't develop significant long-term or late effects of treatment. However, for some patients the effects can range from mild to severe.

Talk to your child's treatment team about possible long-term and late effects. His or her risk for developing long-term or late effects can be influenced by:

  • treatment type and duration
  • age at the time of treatment
  • gender
  • overall health

Some long-term and late effects become evident with maturation (puberty), growth and the normal aging process. Have your child evaluated with a physical exam yearly or more often as needed. Early intervention and healthy lifestyle practices (not smoking, good nutrition, exercise, regular screenings and follow-up) help.

Long-term and late effects can impact your child's physical, mental and cognitive (brain function) health in several ways.

Physical Effects

Children treated for leukemia may be at increased risk for:

  • fatigue
  • growth delays
  • thyroid dysfunction
  • hearing loss
  • a secondary cancer

Mental Effects

Most childhood survivors of cancer are psychologically healthy. However, some studies have indicated that a small number of childhood leukemia survivors were more likely than healthy peers to report changes in mood, feelings and behavior, including depression and posttraumatic stress disorder.

Cognitive Effects

Learning disabilities can begin during treatment or appear months or years afterward. Areas that can be affected include:

  • mathematics
  • spatial relationships
  • problem solving
  • attention span
  • reading
  • spelling
  • information processing
  • planning and organizing
  • concentration skills
  • fine motor coordination

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Returning to School

Once your child is in remission, he or she will likely be going back to school. This reentry to the classroom can be daunting for a child of any age. Educate family members, friends, school personnel and healthcare providers about your child's possible long-term and late effects of treatment. Talk with teachers about your child's needs before he or she returns to school. Work with your child's teachers and medical providers to develop a program tailored to his or her needs that features baseline testing, special accommodations and long-term planning.

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Ongoing Research

Researchers are working to improve their understanding of long-term and late effects and to create guidelines for follow-up care. They're also seeking to understand how factors like aging and social and economic status influence long-term and late effects. LLS is currently funding an initiative at Children's Hospital of Philadelphia to find and eliminate the causes of cancer treatment's late effects.

last updated on Thursday, March 10, 2011
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