Breast cancer, the most prevalent non-skin cancer among women, has led to a significant increase in cancer survivors in the United States, with over 4 million individuals currently. This number is expected to rise to over 20 million by 2026, underscoring the need to understand the long-term effects of breast cancer treatment. Most women are diagnosed at an early stage, with a 5-year survival rate of 89%. However, the risks for developing long-term side effects after breast cancer treatment are multifactorial and include age at the time of diagnosis, comorbidities, and type, dose, and duration of treatment.
Many of these survivors experience long-term and latent effects from cancer treatment. Long-term effects are side effects that arise during treatment and may persist over time, whereas latent effects may not appear until many years after treatment completion. Â Common side effects include lymphedema, cardiotoxicity, fatigue, neuropathy, cognitive dysfunction, endocrine disruptions, infertility, sexual health issues, body image concerns, and mental health issues.
Chemo Treatments
Chemotherapy is the most common form of treatment for cancer, using aggressive drugs to slow the growth of cancer cells. The cancer treatments that may have saved your life may also cause side effects going forward.
For most people, the cancer experience doesn’t end on the last day of treatment. Life after cancer treatment can present challenges as more people live longer after treatment. It’s essential to be aware that long-term side effects, also known as ‘late effects,’ may not begin until months or years after completing treatment. These effects are less well known and vary according to the individual, type of cancer, and type of chemotherapy drug used.
While many cancer survivors diagnosed with early-stage diseases will outlive their cancer, they may continue to experience long-term and/or latent side effects due to cancer treatment. Many of these side effects are common and contribute to worse quality of life, morbidity, and mortality for cancer survivors.
Organ Problems
Some chemotherapy drugs can cause long-term problems with specific body organs. May include issues with your:
- heart
- lungs
- liver
- kidneys
- bladder
Regular health monitoring is a crucial part of your cancer treatment journey. You will have tests before and during your treatment so your doctor can monitor your side effects. Your doctor may continue to check you for some years after specific therapies, ensuring that you receive the best possible care and support. There may be some chemotherapy drugs your doctor won’t use if you have a heart condition.
Latten Effects
Late effects of cancer treatment can come from any of the primary treatment types. These include chemotherapy, hormone therapy, radiation, surgery, targeted therapy, and immunotherapy. As newer cancer treatments become available, these might be found to cause late effects, too.
| Treatment |
Late effects |
| Chemotherapy |
|
| Radiation therapy |
|
| Surgery |
|
| Hormone therapy |
|
| Immunotherapy |
|
| Targeted therapy |
|
Managed Chemotherapy Side Effects
As a patient, you play a crucial role in managing the side effects of chemotherapy. Most of the time, these effects can be effectively managed with medication or adjustments to your chemotherapy under the guidance of your healthcare team.
Medication can manage nausea, vomiting, and fatigue. To manage neuropathy, physicians often lessen a patient’s dosage and prescribe medications to help restimulate nerve growth. It is essential to see your physician before every chemo cycle, especially if you’re in an extreme chemo regime. If symptoms worsen, your dosage may be adjusted.
Patients should disclose their entire medical history before beginning chemotherapy. For example, diabetic patients can receive chemotherapy, but it’s done with caution to prevent more nerve damage and other side effects that are more common in diabetics.
To help manage symptoms at home, patients should do the following:
- Stay hydrated by drinking 1 to 2 liters of water every day.
- Keep items you use frequently, like your phone, close by to reduce the time you spend moving around your house. Less back-and-forth movement can help curb fatigue.
Make a daily task list and use your smartphone or alarms to alert you of important things if you’re experiencing ‘chemo brain,’ a term that describes the cognitive changes that can occur during and after chemotherapy. Go to sleep and wake up simultaneously every day so your body gets used to a routine.
Seeking Medical Attention for Side Effects
While some chemotherapy side effects are minor and likely to subside, others may be alarming and long-lasting. Alert the cancer care team immediately if any of the following occur:
- High fever (100.5 to 101 degrees Fahrenheit)
- Chills that won’t stop
- Bleeding or unexplained bruising
- Allergic reaction that causes pruritus or trouble swallowing or breathing
- Intense headaches or other unusual pain
- Blood in urine or stool
- Difficulty urinating
- Persistent diarrhea or vomiting
Increased risk of additional cancers
Research links chemotherapy to a slight increase in the risk of blood cancer. A 2018 study of 165,820 older adults who underwent chemotherapy for any solid cancer found an increased risk of developing acute myeloid leukemia or myelodysplasia within 5 years.
More research is needed to understand why these cancers develop and whether they can be prevented. Your doctor will help you weigh the risks and benefits of your treatment.
Secondary Cancers
Developing another cancer in the future is a long-term side effect of some chemotherapy drugs. This is called ‘secondary cancer,’ which refers to new cancer that develops because of the original cancer treatment.
It is important to remember that the risk of developing another cancer in the future, known as secondary cancer, is minimal and only occurs with some chemotherapy drugs. You would be at a higher risk of your existing cancer if you didn’t have the treatment your doctor recommends. Your doctor will discuss whether this is a specific risk with the drugs you are taking, providing you with the necessary information to alleviate any fears.
The Importance of Follow-up Appointments
When a follow-up appointment or test is approaching, many people find that they think more about cancer and may feel anxious. Aside from making sure the cancer doesn’t return, follow-up care after chemotherapy is essential to check for any changes in your health.
After chemotherapy, you will have regular appointments with your Oncologist or Hematologist. These appointments are not just about monitoring your health and managing any long-term side effects but also about providing you with the reassurance that cancer hasn’t returned or spread.
During these check-ups, you will usually have a physical examination, and you may have blood tests, X-rays, or scans. You will also be able to discuss your feelings and mention any concerns. Likewise, you may also have regular check-ups with other specialists involved in your treatment.
If you have no further problems, check-ups will become less frequent. After follow-up appointments, immediately inform your doctor of any symptoms or health problems.
Â
SUMMARY
While most chemotherapy side effects are temporary and improve after treatment, some long-term effects may linger or even be permanent, depending on the individual and the type of chemotherapy used.
It is not always possible to prevent long-term side effects from chemotherapy, and there is no way to tell precisely how therapy will affect any given individual. Your cancer team may discuss the risk of long-term effects or permanent issues with a person to help them select the most suitable drugs and therapies.
If you are experiencing any unpleasant side effects, don’t suffer in silence. Talk with your breast care/oncology nurse or doctor about any side effects you may be having. There may be ways to reduce the intensity of your symptoms or alternative medications that suit you better.
Â
References
Banner Health
Canadian Cancer Society
Healthline
Mayo Clinic
MD Anderson Center
Medical News Today
National Library of Medicine
Â
Â
