Survivorship

Late Effects

Frequently Asked Questions

Cancer is now a disease that most people can expect to survive. Each year more patients benefit from early detection of cancer and effective medical treatments, leading to a remarkable increase in long-term cancer survival to a current rate of 66% for adults and 80% for childhood cancer survivors. More than  12 million Americans are now living more than five years after a diagnosis of cancer. Although cured from their cancer, many survivors who have completed their medical treatment are facing challenging late- and long-term effects from their illness and  treatment.

Long-term effects of cancer therapy are medical problems that persist for months or years after treatment ends. Some examples of long-term effects include:

Infertility

Cancer and its treatment may sometimes put cancer survivors at risk for infertility. Infertility for female survivors means not being able to get pregnant or maintain a pregnancy, usually after you have been trying for more than a year. Infertility for male cancer survivors means not being able to produce healthy sperm or to ejaculate sperm.

Infertility may happen in cancer survivors who have treatment or surgery that directly affects their reproductive organs including surgery that removes the uterus, tubes or ovaries in females or that removes the prostate and seminal vesicles in males.  Radiation treatments directed to cancer near or in the area of the reproductive organs (abdomen, pelvis, testicle) can also lead to infertility depending on the doses that were administered.  There are also a variety of chemotherapy medicines that can lead to temporary or permanent problems with fertility.  Your oncologist, survivorship clinic, or other health care provider can determine if the treatment you received puts you at risk for infertility.  There are specific tests for males and females that can be done to determine your fertility status.  Additionally, there are potential treatments for some forms of infertility that can be considered.   

Treatment-related fatigue

Fatigue in survivors is often a lack of stamina, where it suddenly seems you can't go on, or you just don't have the energy you used to have.  This is different from the fatigue during treatment when you may have felt tired even when getting normal sleep. Fatigue is very common in cancer survivors. Fatigue may be difficult to describe and people describe it in a variety or ways, using terms such as tired, weak, exhausted, weary, worn-out, lack of energy. Survivors may also experience exercise intolerance or lack of stamina to keep going with activities.

Many cancer survivors experience chronic fatigue after their active cancer treatment has ended. Survivors can experience chronic fatigue because of the treatment they received for their cancer, but also because they have been inactive during treatment or as a result of emotional changes  after battling cancer.

Some medical causes of fatigue - such as anemia and low thyroid hormone levels - may be treatable, as may some emotional factors. Exercise has been shown to improve fatigue from almost any cause.  If you are experiencing fatigue you should have your oncologist, survivorship clinic or primary care provider evaluate you for medical and emotional conditions and consider referring you for an exercise program. 

Late effects are medical problems that do not develop or become apparent until years after treatment ends. Some examples of late effects include:

Heart disease

Most cancer survivors do not develop heart problems; however, certain types of treatment can affect the heart. It is therefore important for cancer survivors to know whether any of their treatments put them at risk for heart ailments. That way, they can take steps to keep their heart healthy and receive regular medical check-ups and tests to monitor heart function. If a problem develops, it can be detected and treated early.

These are just a few of the  long-term and late effects that can result from cancer and its treatment. Most survivors will not develop serious complications, but if they do occur, it is best to catch them and start treatment right away.  This is why ongoing follow-up care for cancer survivors is so important. The Institute of Medicine recommends that cancer survivors receive a treatment summary and Survivorship Care Plan after completing their medical treatment. Contact your oncologist or cancer treatment facility to request a treatment summary and Survivorship Care Plan. If you are no longer  with your treating oncologist or cannot obtain these documents through your treatment facility, consider an appointment in the Survivorship Program's clinic at the Seattle Cancer Care Alliance. To schedule an appointment in this clinic please call 206-288-2216 or email us at survivor@fhcrc.org.

Frequently Asked Questions  

Q. Can long-term or late effects from cancer include emotional and relationship issues?

Although cured from their cancer, many survivors who have completed their medical treatment face distressing long-term and late effects from their illness and treatment. These effects can include physical issues such as lymphedema, loss of bone density and cardiovascular disease, but significant psychosocial effects can also persist. The psychosocial effects most often reported by cancer survivors include anxiety, depression, cognitive dysfunction, information and communication needs, relationship concerns and work/employment concerns. Fatigue is complex because it can have both physical and psychosocial causes and effects.

Ongoing follow up for cancer survivors is recommended in order to identify and treat these effects. Interventions include education, cognitive-behavioral therapy (CBT), support groups, individual psychotherapy, coping skills training, and meditation or relaxation training. Talk to your health care provider about any issues you may be facing and ask about possible treatment options