Introduction:

• Individuals who have survived cancer free for longer than 5 years are called survivors and they are considered as cured.
• Numbers of survivors is increasing steadily

Late complications in survivors:

• Cardiac
  • Anthracycline induced cardiomyopathy
  • Radiation- Induces valvular abnormalities, Coronary artery disease, pericardial effusion, constrictive pericarditis
  • HSCT- Increased risk of cardiovascular event
• Pulmonary:
  • Interstitial lung disease in patients receiving bleomycin
• Endocrine:
  • Hypothyroidism due to cervical irradiation
  • Poor linear growth due to CNS irradiation
  • Obesity- Seen in survivors of ALL
  • Gonadal dysfunction due to radiation and alkylating agents
• Musculo-skeletal effects:
  • Osteonecrosis especially with steroids
  • Osteoporosis with steroids, methotrexate, cranial irradiation with resultant hypopituitarism
• Neurocognitive effects
  • Decreased IQ in ALL patients who receive CNS targeted therapy
  • Various leukoencephalopathies
• Ocular
  • Cataract with use of steroids and following cranial irradiation
  • Xerophthalmia with chronic GVHD
• Audiologic
  • Deafness with platinum chemotherapy, cranial irradiation and aminoglycosides
• Dental:
  • Qualitative problems with enamel and root development in children
  • Dental caries
  • Gingivitis
  • Hepatic
  • Chronic hepatitis due to viruses, chemotherapy toxicity
• Secondary malignancies
  • Therapy related AML/MDS
  • Thyroid cancers- Papillary carcinoma
  • Lymphoma
  • Ca breast
  • Bone/ soft tissue sarcoma
  • CNS tumors
• Psycho-social effects:
  • Anxiety
  • Depression
  • Fear of recurrence, disfigurement
  • Unemployment
  • Denial of health insurance
  • Breakdown of marriage or relationship
  • Post traumatic stress disorder

Fertility Issues

• Before any chemotherapy is given to adolescents and young men they should be counseled about the possibility of loss of fertility.
• Collect the sperms if needed before start of chemotherapy
• Chances of infertility in women after chemotherapy are less. 
• Women should avoid pregnancy during chemotherapy to prevent likely damage to embryo and fetus.