Late Effects of Cancer Treatment

What Are Late Effects of Cancer Treatment?

Late effects are problems caused by cancer treatment that may not show up for months or years after treatment. These problems are specific to certain types of treatments and the dose received. Like side effects that you may have during treatment, late effects differ greatly from person to person. You may have problems that are very different from someone else’s, even if they had the same type of cancer and treatment. When you discuss follow-up care with your doctor, you may want to ask about which late effects to watch for. Early medical attention can prevent or help better manage late effects. See Follow-Up Medical Care to learn more.

Living a healthy lifestyle can help you feel better overall and manage certain late effects, such as heart and lung problems. See Guidelines for a Healthy Lifestyle to learn more.

Bone Loss

Chemotherapy, steroid medicines, hormonal therapy, or radiation therapy may cause thinning of the bones. With radiation therapy, bone loss will occur only in the part of the body that was treated.

Ways to Manage

Once you’ve had cancer, you should have regular check-ups. During these visits, your doctor or nurse will do a physical exam and may order tests to check your bone health. You can help lower your risk of bone loss by:

• not smoking or using other tobacco products
• eating foods that are rich in calcium and vitamin D
• walking, jogging, or other weight-bearing exercises
• limiting how much alcohol you drink

If you had radiation to the head and neck, also see Mouth Changes on this page for tips on managing possible bone loss in your jaw.

Brain Changes

Some chemotherapy drugs and radiation therapy to the brain can cause problems with thinking and behavior months or years after treatment. Late effects that may occur depend on the part of the brain that was treated and may include:

• memory loss
• problems doing math
• problems concentrating
• slow processing of information
• personality changes
• movement problems

In rare cases, radiation to the brain can cause radiation necrosis. This problem may happen when an area of dead tissue forms at the site of the brain tumor. Radiation necrosis can cause movement problems, problems concentrating, slow processing of information, and headaches.

Ways to Manage

If you have symptoms of brain changes, you may have tests to see whether they are caused by cancer in the brain or are late effects of treatment. If you have late effects, your doctor or nurse:

• will talk with you about ways to manage these effects
• may refer you to a physical, occupational, or speech therapist who can help with brain problems
• may prescribe medicine or suggest surgery to help with the symptoms

See Memory or Concentration Problems to learn more about brain changes caused by cancer treatment.

Endocrine System Changes

Some cancer drugs and radiation can damage parts of the endocrine system. The endocrine system is a collection of organs and glands that control body functions such as growth, sexual development, reproduction, sleep, hunger, and the way the body uses food.

Parts of the endocrine system that may be damaged by cancer treatment include the thyroid, ovaries, and testes. Radiation to the head and neck may damage the thyroid. Radiation to the pelvis may damage the ovaries in women or the testes in men. Problems caused by these changes can develop many years after treatment and may include early menopause, infertility, underactive thyroid, overactive thyroid, and weight gain.

Ways to Manage

Early menopause: See Hot Flashes and Night Sweats for more information about managing the symptoms of early menopause.

Sexuality and fertility: For information about sexual problems or managing infertility, see:
Sexual Health Issues in Women
Fertility Issues in Girls and Women
Sexual Health Issues in Men
Fertility Issues in Boys and Men

Thyroid problems: If you develop underactive thyroid, your doctor may prescribe thyroid hormone replacement therapy and closely watch your response to the medication. If you develop overactive thyroid, treatment may include:

• drugs that prevent the thyroid from making hormones
• radioactive iodine to destroy the thyroid
• surgery to remove the thyroid
• beta-blockers to help with symptoms such as a fast heartbeat, anxiety, or shaking 

Eye Problems

Chemotherapy, hormone therapy, immunotherapy, and steroid medicines may increase the risk of cataracts. Cataracts are a problem in which the lens of your eye becomes cloudy. Cataracts can cause:

• blurred, cloudy, or double vision
• sensitivity to light
• trouble seeing at night

Some chemotherapy drugs can cause dry eye syndrome. This is a problem in which your eyes do not produce enough tears. Symptoms include feeling as if your eyes are dry or have something in them.

Ways to Manage

If you are at risk for cataracts, you should have regular visits with an ophthalmologist (a medical doctor who treats eye problems).

If cataracts become serious, they can be treated with surgery. In this type of surgery, an eye surgeon will remove the clouded lens and replace it with a plastic lens. You will usually have local anesthesia and be able to go home the same day.

If you develop dry eye syndrome, your doctor may prescribe regular treatment with eye drops or ointments. Or they may suggest that you have a procedure to block tear ducts. Blocking the tear ducts prevents tears from draining away which helps keep the eyes moist. 

Hearing Problems

Treatment with certain chemotherapy drugs (in particular, cisplatin and high doses of carboplatin) and high doses of radiation to the brain can cause ringing in the ears (called tinnitus) or hearing loss that begins months or years after treatment.

Ways to Manage

See an audiologist. An audiologist is a health care professional trained to find, assess, and manage problems with hearing, balance, and other issues having to do with the ear. They can also fit you for hearing aids or other devices to help with hearing loss.

If you had cancer treatment that can cause hearing problems, you should have at least one visit with an audiologist after you have finished the treatment. Depending on the type and dose of cancer treatment that you received, you may need to see an audiologist often. 

Protect your hearing. Avoid loud noises. Wear earplugs when using loud equipment, such as lawn mowers, leaf blowers, and power washers. Also, wear earplugs during concerts and other loud indoor events.  

When listening to headphones, be careful not to turn the volume up too high. 

Watch for signs of hearing loss. Let your doctor know right away if you have ringing in the ears or notice other changes in your hearing.

Heart Problems

Certain cancer drugs and radiation therapy to the chest may cause heart problems that don’t show up until years after treatment. Drugs that tend to cause heart problems include:

• trastuzumab
• doxorubicin
• daunorubicin (Cerubidine)
• epirubicin (Ellence)
• cyclophosphamide (Neosar)

Heart problems caused by cancer treatment may include:

• A weakening of the heart muscle, known as congestive heart failure. People with this condition may have shortness of breath, dizziness, and swollen hands or feet.
• Coronary artery disease, which occurs when the small blood vessels that supply blood and oxygen to the heart narrow. People with coronary artery disease may have chest pain or shortness of breath. This problem is more common in those who had high doses of radiation therapy to the chest.

Ways to Manage

If you have heart problems caused by cancer treatment, your doctor or nurse might suggest that you:

• Eat a heart-healthy diet. A heart-healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. Your doctor will probably suggest that you follow a diet low in salt because salt can cause extra fluid to build up in your body, making heart problems worse. The American Heart Association has many tips for heart-healthy eating.
• Lose weight if you're overweight or obese. Carrying extra weight can put added strain on your heart. Work with your health care team to lose extra weight safely.
• Exercise. The right type and amount of exercise can help keep you and your heart healthy.  Talk with your doctor about which activities you can safely do. 
• Quit smoking and avoid using drugs not prescribed by a doctor. Smoking tobacco and marijuana exposes users and those nearby to many harmful substances. Both smoking and taking drugs can make heart failure worse and harm your health. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. For help to quit smoking, visit Smokefree.gov or call toll-free, 1-800-QUIT-NOW (1-800-784-8669).
• Get enough rest. To learn more about how to manage sleep problems, see Sleep Problems.
• Take medicines prescribed by your doctor. Your doctor may prescribe medicines based on the type of heart problem you have, how severe it is, and your response to certain medicines. Taking these medicines is important.

Joint Changes

Radiation therapy, some chemotherapy drugs, and steroids can cause scar tissue to form in the joints. These problems can lead to loss of motion in joints, such as your jaw, shoulders, hips, or knees. If you receive radiation therapy, these problems will occur only in the part of the body that was treated.

Ways to Manage

It is important to be aware of early signs of joint problems so these can be addressed before they get worse. These signs include:

• trouble opening your mouth wide
• pain when you make certain movements, such as reaching over your head or putting your hand in a back pocket

Talk with your doctor or nurse. They may refer you to a physical therapist who will assess your joint problems and give you exercises to do. Physical therapy exercises can decrease pain, increase strength, and improve movement. In some cases, your doctor may recommend a knee or hip replacement.

If you had radiation to the head and neck, also see Mouth Changes on this page for tips on managing possible bone loss in your jaw.

Lung Problems

Chemotherapy and radiation therapy to the chest may damage the lungs, but you might not notice problems until years after treatment. Cancer survivors who received both chemotherapy and radiation therapy to the chest may have a higher risk of lung damage. Lung damage can cause shortness of breath, wheezing, fever, dry cough, congestion, and feeling tired. Tell your doctor if you have any of these symptoms.

If you have symptoms of lung damage, you will have tests to see whether they are due to cancer in the lungs or are late effects of treatment.

Ways to Manage

Oxygen therapy. If you have serious trouble breathing, your doctor may prescribe oxygen therapy. Oxygen is most often given through nasal prongs or a mask that fits over your mouth and nose. In some cases, you might receive oxygen through a ventilator.
Lose weight if you're overweight or obese. Excess weight can make it hard to breathe. Work with your doctor and health care team to lose excess weight safely.
Exercise. Talk with your doctor about which activities you can safely do. 
Quit smoking, don’t vape, and avoid using drugs not prescribed by a doctor. Smoking tobacco or marijuana exposes smokers and those nearby to many harmful substances. Smoking, vaping, and taking drugs can make lung problems worse and harm your health. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. For help to quit smoking, visit Smokefree.gov or call toll-free, 1-800-QUIT-NOW (1-800-784-8669).
Take medicines prescribed by your doctor. Your doctor can prescribe medicines to help you relax when it is hard to breathe, relieve discomfort, and treat pain.
Some people with lung problems take steroid drugs. Steroids can interfere with the way the body uses specific nutrients, including calcium, potassium, sodium, protein, and vitamins C and D.

If you take steroid pills for lung problems, it is very important to maintain a healthy weight by eating a balanced diet. A healthy diet that includes foods from each food group can make up for some of the effects of steroid therapy. To learn more about eating a healthy diet, see Start Simple with MyPlate Today or MyPlate.gov. 

Lymphedema

Lymphedema is a problem in which the lymph fluid does not drain as it should, builds up in the tissues, and causes swelling. You may be at risk for lymphedema if part of your lymph system is damaged during surgery to remove lymph nodes or by radiation therapy to areas with large numbers of lymph nodes. Lymphedema can develop many years after treatment.

See the Lymphedema page for more information, tips for managing, and signs to look for.

Mouth Changes

Radiation therapy to your head or neck and some chemotherapy drugs can cause late side effects in your mouth. Problems may include dry mouth, cavities, or bone loss in the jaw.

Ways to Manage 

Visit your dentist. You may need to have your teeth checked every 1 to 2 months for at least 6 months after radiation treatment. During this time, your dentist will look for changes in your mouth, teeth, and jaw.
Exercise your jaw. Your doctor or nurse may suggest that you open and close your mouth 20 times as far as you can without causing pain, three times a day, even if your jaw isn’t stiff.
Stimulate saliva. Your doctor or nurse may suggest that you drink 8 to 10 cups of liquid per day. Keep a water bottle handy so you can sip throughout the day. You may also find sucking on sugarless candy or chewing gum helpful.
Take good care of your teeth and gums. Floss and use a mouthwash with fluoride every day. Brush your teeth after meals and before you go to bed. Also, avoid mouthwashes that contain alcohol.
Explore your treatment options. Ask your dentist to contact your radiation oncologist before you have dental or gum surgery. There may be other treatment options besides surgery. Also, most dentists advise that you do not have teeth pulled from the part of your mouth that received radiation.

Post-traumatic Stress

Finding out you have cancer, having treatment for cancer, and living with cancer can cause extreme feelings that persist and many stressful events that repeat over time. These feelings and events can pile up and cause post-traumatic stress. Symptoms of post-traumatic stress can occur at any time, even years after your first treatment for cancer. 

Symptoms of post-traumatic stress may include:

• frightening thoughts
• trouble sleeping
• being distracted
• feeling hyper
• feeling alone
• losing interest in daily activities
• feelings of shock, fear, helplessness, or horror

If these symptoms cause distress and interfere with daily life, be sure to tell your doctor. Your doctor can refer you to a social worker, therapist, palliative care specialist, or pastoral counselor. These experts can assess your symptoms and suggest treatment, such as relaxation training, counseling, support groups, and certain medicines.

For more information about post-traumatic stress and how to cope, see Coping with Cancer, Cancer-Related Post-traumatic Stress, and Adjustment to Cancer: Anxiety and Distress.

Second Primary Cancers

Cancer treatment can sometimes cause a new cancer many years after you have finished treatment. When a new primary cancer occurs in a person with a history of cancer, it is known as a second primary cancer. Second primary cancer is not the same thing as metastatic cancer, which is when cancer spreads from where it started. 

Second primary cancers do not occur very often. When they do occur, they are not always caused by cancer treatment. 

Ways to Manage

• Talk with your doctor about the types of second cancers you may be at risk for.
• Have regular check-ups for the rest of your life to check for cancer—the one you were treated for and any new cancer that may occur. Your doctor can suggest tests you may need to look for cancer and how often you should have them.
• Tell your doctor if you notice any changes in your body that last longer than a few weeks.

Clinical Trials for Managing Late Effects

To find clinical trials for managing symptoms and side effects and improving quality of life, use this advanced search form. Under “Keywords/Phrases,” type the specific treatment or symptom that you are interested in. Under “Trial Type,” select the box for "Supportive Care" trials. If you need help findings trials, contact the Cancer Information Service, NCI’s contact center.