Understanding long term side effects allow you to take positive steps towards optimal health as a cancer survivor.
“Those of us who have been through cancer know that surviving treatment isn’t where the cancer journey ends. In fact, for many of us, this is where the hardest part of the journey begins.” - Saskia Lightstar, The Cancer Misfit: A Guide to Navigating Life After Treatment
There has been tremendous progress made in diagnosing and treating many cancers over the past few decades such that many cancer survivors diagnosed with the early-stage disease will certainly outlive their cancer. A cancer diagnosis is no longer synonymous with death. In many situations, cancer is almost a chronic disease much like diabetes or hypertension with multiple cycles of treatment and remission.
New data shows that the number of cancer survivors in the United States will exceed 22 million by 2030.
While this is great news for cancer patients, there are significant challenges that cancer survivors face including long-term and latent physical side effects of treatment, psychological and emotional trauma as well as socio-economic ramifications that can take a tremendous toll on the patient and their families. Depending on the type of cancer treatment these short or long term common side effects can vary. Treatment is personalized based on the type of cancer, the health, age, and comorbidities of the patient as well as standard of care.
The more common types of treatments include:
Surgery offers a range of treatments that include the removal of cancer cells via an operation. This is based on the size, location, and intent which can be to remove the entire cancer, debulking or reducing the size of the tumor, or ease associated common side effects such as pain and pressure on adjacent organs.
Utilizing IV or oral drugs, cancer cells can either be destroyed or their development inhibited. Chemotherapy not just destroys or limits the development of cancer cells, but also affects the production of normal healthy cells. Fatigue, nausea, and hair loss are some of the most common negative effects. Many of these adverse effects are manageable and transient.
Radiation therapy treatment includes high doses of radiation to kill cancer cells via DNA damage. People with cancer can get this treatment done via an external machine (external beam radiation) or internally (brachytherapy).
Bone marrow transplant:
Also known as stem cell transplant. Stem cell transplants do not usually work against cancer directly except in the case of multiple myeloma or some types of leukaemia. Instead, they help your body to produce stem cells after treatment with high doses of radiation therapy, chemotherapy, or both which is standard of care.
Immunotherapy uses your body's immune system to target and kill cancer cells. There are different types of immunotherapies including the more common types such as monoclonal antibodies, cancer vaccines, and immune checkpoint inhibitors.
Hormone therapy works by blocking the body’s ability to produce hormones or by interfering with how hormones act in the body. This can cause various common side effects depending on the type of hormones targeted by the treatment.
Targeted drug therapy:
It is a type of cancer treatment that targets proteins that control how cancer cells grow, divide, and spread throughout the body. The most common types are small-molecule drugs or monoclonal antibodies.
This treatment uses extreme cold produced by liquid nitrogen or argon gas to destroy cancer cells and abnormal tissue. It is a local treatment performed using cryoprobes, which means that it is directed toward a specific part of your body while relatively sparing healthy tissues.
To eliminate cancer cells, radio frequency ablation utilizes heat generated by electrical energy. It entails putting catheter probing into a specific bodily location. The probe sends out radio frequency waves further into surrounding tissue, causing adjacent cells to die. The immune system eliminates these cells when they perish.
Long term and latent physical effects of cancer treatments on cancer survivors.
Long term side effects of chemotherapy arise during treatment and may persist over time, whereas certain symptoms may include latent effects many years after treatment completion. These side effects of chemotherapy can overlap and exist on a continuum through treatment and survivorship. The four most common cancers include breast, lung, colon, and prostate cancers.
Long-term common side effects of chemotherapy drugs in breast cancer patients include lymphedema, cardiotoxicity, heart failure, chronic fatigue, peripheral neuropathy (nerve damage), cognitive dysfunction including chemo brain, endocrine disturbances including early menopause, poor bone health, pain in the head and neck, infertility, sexual health issues, and mental health issues. Hair loss which can be temporary but traumatic can sometimes come back with altered texture and decreased abundance.
In colon cancer patients, bowel and bladder dysfunction affects nearly a third to half of patients receiving chemotherapy and radiation. In addition, there is always an increased risk of sexual dysfunction, neuropathy, and chronic pain in survivors.
Long-term lung cancer survivors face decreased or disrupted lung problems as related to the function of breathing or other lung problems like damage resulting in the chronic shortness of breath, chronic fatigue, neuropathy, skin changes, lung tissue damage, dry mouth, hypertension, and other lung problems related to oesophageal narrowing and cardiac dysfunction.
Prostate cancer patients, depending on the modalities of treatment received, can end up with proctitis (rectal inflammation), cystitis (bladder inflammation), urinary or rectal bleeding and changes in the frequency of urination, rectal ulcers, narrowing of the rectum or urethra, chronic diarrhoea, and fertility issues.
In addition to the specific issues that arise for each type of these cancers, nearly all patients report some level of acute and chronic fatigue as well as mental health impact when they talk with their doctor.
“Dealing with it is the operative word. I found myself at seven years, not battling it. Not struggling with it. Not suffering from it. Not breaking under the burden of it, but dealing with it.” - Michael J Fox
Side effects related to chemotherapy can last for varying lengths
When it comes to side effects of chemotherapy, there is no set timeline because everyone reacts differently to chemotherapy.
Some side effects appear almost immediately during treatment while others may not start until treatment is finished and last long after the treatment is over. Long term side effects of chemotherapy may not occur until months or even years post-cancer treatment. Letting your cancer care team know immediately as your side effects develop will help you manage these complications and ease your road to recovery. Modern medicine has radically changed how we manage cancer treatment and its side effects, paving the path for long survivorship, improving your quality of life, and personalizing your care so you can live your best life.
The road to recovery and being physically active post-treatment can be bumpy. Don’t expect your life to go back to the way it was before your diagnosis. The road to health and wellness will take time, patience, consistent behavioural change, and a support system. Every person has a different perspective and coping with all the changes, physical, mental, and emotional can be difficult. We know that many cancer survivors, especially those diagnosed at early-stage, will outlive their cancer and die of other comorbidities. Given the advances in treatment options, the long term effects of cancer treatments will play a significant role in the survivors’ quality of life, morbidity, and overall mortality. It is important that you have productive conversations with your cancer care team and set realistic expectations. There are other issues not directly related to your treatment but just as critical including navigating a complex healthcare system, poor integration of survivorship care between specialized and primary care providers, financial hardships related to cancer treatment as well as home and work-related modifications, which you may or may not be able to talk about with your doctor. Being prepared and making adjustments to your lifestyle will go a long way in helping you live your best life.
Reason to hope: The National Cancer Institute provides a comprehensive list of support organizations that can assist throughout your cancer journey. Here is the link: