Long-term and late effects of blood cancer treatment

Blood cancer survivors don't always have serious long-term or late effects of treatment. For those who do, some long-term effects, such as fatigue, can linger for months or years after therapy. Late effects, such as medical conditions like heart disease and other cancers, don't appear until years after treatment ends. Effects can range from mild to severe.

Talk with your doctor about possible long-term and late effects. Your risk for developing long-term or late effects can be influenced by your:

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

Types of long-term and late effects 

Cognitive effects

Cancer treatments such as chemotherapy and radiation therapy can cause problems with mental functions, such as concentration, memory, and the ability to multitask (to keep track of and do different tasks at the same time). These effects are sometimes referred to as "chemobrain" or brain fog.

Psychological effects

You might experience long-term psychological effects after treatment ends, including depression or post-traumatic stress disorder. 

Physical effects

You may experience these physical effects after treatment ends. 

Chemotherapy and other drug therapies

Depending on your treatment type and length and your individual risk factors, including genetics and overall health, you may be at risk for:

• Heart conditions/damage (chronic heart failure, heart muscle injury)
• Thyroid problems
• Lung damage (scarring, inflammation, acute respiratory distress syndrome, lung failure)
• Infertility, including premature ovarian failure and premature menopause in women and women assigned at birth and low testosterone levels and sperm counts in men and men assigned at birth
• Osteoporosis (low bone density)
• Hearing loss
• Cataracts
• Secondary cancers, such as acute myeloid leukemia and myelodysplastic syndromes
• Peripheral neuropathy
• Impaired immune system function 

Radiation therapy 

Radiation therapy uses ionizing radiation to kill cancer cells. For this reason, some cancer survivors who have had radiation therapy to the head and neck can develop:

• Hypothyroidism or hyperthyroidism
• Hearing loss
• Vision problems, such as cataracts or glaucoma
• Dental abnormalities, such as dry mouth or cavities
• Brain or thyroid cancer
• Osteoporosis (low bone density)

Radiation therapy to the chest can cause:

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

Radiation to the breast area increases the risk of developing breast cancer years after treatment. Talk to your doctor about recommended screening.

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

Effect on daily activities

Cancer treatment's cognitive, psychological, and physical effects might affect your everyday activities. Support and help are available for cancer patients and survivors, who may face:

• Job discrimination
• Difficulty getting health or life insurance
• Financial issues
• Relationship or social problems
• Lack of follow-up care

Managing long-term and late effects

Many long-term and late effects of treatment can be managed. Work closely with your doctor and follow these tips to help keep long-term and late effects at bay:

• Keep a record of any physical or emotional symptoms you experience and discuss them with your treatment team
• Keep all medical records, including dates and locations of cancer treatment, drugs and supportive therapies (such as blood transfusions), and doses and specific sites and amounts of radiation therapy. Keep copies of blood, marrow, and imaging test results (MRIs, CT scans, X-rays).
• Follow a health plan that includes regular exercise, using sun protection, and eating healthy foods. Don't smoke or use tobacco products. If you smoke, ask your healthcare professionals to help you quit.
• Keep your medical follow-up appointments
• Stay informed. Ask your treatment team for the latest information on long-term and late effects of cancer treatment or contact an Blood Cancer United Information Specialist.

Ongoing research

Researchers are working to improve their understanding of long-term and late effects and create guidelines for follow-up care. If you'd like to contribute to this important research, you can take part in a clinical trial that collects data on long-term and late effects.