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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. For children who receive intensive chemotherapy, including anthracyclines, ongoing monitoring of cardiac function is critical since these drugs may affect the heart. Periodic examination of kidney function and auditory exams are also recommended.

Talk to the 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 the following factors:

  • Treatment type and duration
  • Age at the time of treatment
  • Sex
  • Overall health

Some long-term and late effects become evident with maturation (puberty), growth and the normal aging process. Have the 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 a child's physical, mental and cognitive health in a number of ways.

Physical Effects. Children treated for acute myeloid leukemia may be at increased risk for issues including the following:

  • Fatigue
  • Growth delays
  • Bone health issues
  • Damage to heart, thyroid or other organs
  • Obesity
  • Fertility problems
  • A secondary cancer

Treatment may affect fertility (the ability to have a child in the future). Talk to the child's treatment team for a referral to a fertility specialist before beginning treatment. Learn more about how cancer and treatment can affect fertility.

Psychological 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 (PTSD).

Cognitive (Learning) Effects. Learning disabilities can begin during treatment or appear months or years afterward. Areas that can be affected include the following:

  • Mathematics
  • Spatial relationships
  • Problem solving
  • Attention span
  • Reading
  • Spelling
  • Information processing
  • Planning and organizing
  • Concentration skills
  • Fine motor coordination

Talk to your child’s healthcare team about any educational or learning issues that cause concern. A pediatric psychologist can perform neuropsychological testing to evaluate your child for any signs of these potential late effects.

 Read the PDF, Beyond Treatment, for more information on survivorship and life after treatment.

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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