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Physical Effects

Chemotherapy and Other Drug Therapies

Children treated with chemotherapy, drug therapy or other therapies may be at increased risk for the following side effects. Click here to read more about these side effects.

  • Fatigue
  • Growth delays
  • Thyroid dysfunction
  • Bone or joint pain or other bone health issues 
  • Secondary cancers, such as acute myeloid leukemia, myelodysplastic syndromes, brain tumors, breast cancer, osteosarcoma (bone cancer)
  • Heart conditions/damage (chronic heart failure, heart muscle injury)
  • Lung damage (scarring, inflammation, acute respiratory distress syndrome, lung failure)
  • Peripheral neuropathy

Cancer treatment may also affect fertility, the ability to conceive or father a biological child. The risk of fertility issues depends on the specific treatment.  
Radiation Therapy

Radiation therapy uses ionizing radiation to kill cancer cells. Due to damage of nearby tissues, patients who receive radiation treatment may be at risk for side effects later in life, such as secondary cancers and organ damage. The risk depends on the area treated and the type and dose of radiation used. Current radiation methods available can minimize the damage done to nearby tissues.

Children who have had radiation therapy to the head and neck can develop:

  • Growth hormone deficiency
  • Hypothyroidism or hyperthyroidism
  • Hearing loss
  • Vision problems such as cataracts or glaucoma
  • Dental abnormalities
  • Brain or thyroid cancer
  • Osteoporosis (low bone density)

Some children who receive radiation to the brain may not reach puberty at the normal age. A small percentage experience premature puberty, while in other children puberty is significantly delayed.

Radiation therapy to the chest can cause:

  • Lung damage (scarring, inflammation, breathing difficulties)
  • Heart damage (scarring, inflammation, coronary heart disease)
  • Breast cancer
  • Thyroid cancer
  • Hypothyroidism or hyperthyroidism

Children who receive radiation therapy to the neck and chest or total body irradiation (TBI) before a stem cell transplant have an increased risk for breast cancer later in life. Current recommendations for female patients include monthly breast self-examinations; an annual clinical breast examination until the age of 25 years and then every 6 months; yearly mammogram starting at the age of 25 years or 8 years after radiation therapy, whichever happens later. Men should have careful lifelong follow up.

In boys, radiation therapy to the testes or stomach radiation may cause fertility problems. In girls, stomach radiation may cause fertility problems including premature ovarian failure or premature menopause. The effect of radiation on the ovaries and testes depends upon age, dosage and location.

Total body irradiation for individuals undergoing a hematopoietic stem cell transplant can potentially cause ovary or testes failure, leading to fertility issues. High-dose radiation to the spleen can increase the risk of developing repeated bacterial infections.

 Read the PDF, Side Effects and Supportive Care, for more information.

 Read the Long-Term and Late Effects section of the PDF, Beyond Treatment, for more information.

Children's Oncology Group 

The Children’s Oncology Group provides recommendations for monitoring late effects in the resource Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. The information is reviewed and updated regularly by experts in survivorship care. The guidelines are written for healthcare professionals; therefore, it is best to review the guidelines with the help of your child’s healthcare team. The “Health Links” documents provided with the guidelines are written for patients and their families. As you read through these resources, write down any questions you want to address with members of your child’s healthcare team. Visit to download the guidelines and Health Links.

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