When people think of cancer treatment, they often focus on immediate side effects like nausea and fatigue. However, long-term and late side effects can arise months or even years after treatment and can significantly impact the quality of life. In this blog, we’ll explore what late and long-term side effects are, the common issues that arise, and how cancer survivors can manage and cope with these challenges. 

Long-Term vs. Late Side Effects 

Long-term side effects persist during or shortly after treatment and continue for months or years. Examples include chronic fatigue, pain, or changes in skin and organ function, such as neuropathy from chemotherapy or joint issues from hormone therapy. 

Late side effects emerge months or years after treatment ends and can include secondary cancers, heart disease, or cognitive issues like memory problems. They typically result from the cumulative effects of treatment or the body’s delayed response. 

Common Long-Term and Late Side Effects 

Around 60% of cancer survivors face at least one long-term or late effect of treatment, including physical, emotional, and cognitive challenges. ^{(1) (2)}  

Long-term and late side effects vary based on the type of cancer treatment and the individual. Some people may not experience significant side effects, while others may face ongoing challenges. The likelihood of side effects depends also on the type of treatments received and the area of the body treated. For example, chemotherapy is more likely to cause neuropathy ^{(3) (4)}, while radiation can result in cardiovascular issues ^{(5) (6)} or bone health problems ^{(7) (8)} 

Generally, brachytherapy tends to have fewer long-term side effects than EBRT and chemotherapy^{. (9) (10)}.  

Some of the most prevalent long-term and late side effects experienced by cancer survivors include: 

• Chronic pain: According to the American Cancer Society and a study published in JAMA Oncology, approximately 25-30% of cancer survivors experience chronic pain ^{(11)  (12)} 

• Fatigue: Studies show that up to 35% of survivors report persistent fatigue after treatment ^{(13) (14)} 

• Bowel and Bladder Issues: Surgical and radiation treatments can lead to long-term issues, such as urinary incontinence or bowel obstructions. 

• Cardiovascular Problems: Some cancer treatments increase the risk of developing heart disease. 

• Bone Health: Treatments may lead to osteoporosis or bone density loss. 

• Neuropathy: Chemotherapy and other treatments can damage nerves, leading to pain, tingling, or numbness, particularly in the hands and feet. 

• Emotional and Psychological Effects: Anxiety, depression, and the fear of cancer recurrence are common emotional challenges that survivors face. You can read our blog on Managing uncertainty after cancer 

Strategies for Managing Long-Term and Late Side Effects 

Stay Informed and Monitor Your Health Stay aware of potential side effects from your cancer treatment for early management. Keep a health journal to track symptoms and share them with your healthcare provider during follow-ups. Monitoring fatigue, nerve damage, and cognitive or cardiovascular changes ensures timely intervention and improves treatment outcomes. Routine check-ups are crucial for catching new issues early. 

Healthy Lifestyle Engaging in a balanced diet, regular physical activity, and stress management techniques are crucial in managing long-term side effects. A healthy lifestyle can also support your body’s recovery by strengthening bones and cardiovascular health. Avoid smoking and excessive alcohol consumption to protect your health further. 

Manage Emotional and Psychological Well-being Survivorship often brings emotional challenges like anxiety, depression, and fear of recurrence. Seeking professional counseling, joining support groups, or using mindfulness and relaxation techniques can help you cope. Many cancer survivors find comfort and encouragement through peer support, which provides practical advice and emotional relief. 

Physical Therapy and Rehabilitation Physical therapy can significantly improve daily function and mobility for side effects such as muscle weakness, joint pain, or lymphedema. A rehabilitation specialist can create a personalized recovery plan to address your unique needs, helping you regain strength and reduce discomfort over time. 

Medication and Pain Management Chronic pain and discomfort are common long-term side effects that can persist even after treatment. Over-the-counter medications, prescription pain relievers, and integrative therapies like acupuncture may help manage symptoms. Always consult your doctor before starting new drugs or medicines to ensure they align with your treatment plan. 

Managing long-term and late side effects is an integral part of cancer survivorship. You can improve your quality of life after treatment by staying informed, attending regular follow-up appointments, maintaining a healthy lifestyle, and addressing physical and emotional challenges. With the right strategies and support, survivors can actively manage these side effects and continue to thrive beyond their cancer journey. 

References 

1. Joshy, G., Khalatbari-Soltani, S., Soga, K. et al. Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer. BMC Cancer 23, 774 (2023). https://doi.org/10.1186/s12885-023-11214-5  
2. Nina N. Sanford, MD ; David J. Sher, MD ; Santino S. Butler, BA et al. Prevalence of Chronic Pain Among Cancer Survivors in the United States, 2010-2017. DOI: 10.1002/cncr.32450, June 14, 2019, Published online August 22, 2019 in Wiley Online Library. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.32450 
3. Peripheral Neuropathy Clinical Trials – Mayo Clinic Research 
4. Chemo Induced Peripheral Neuropathy | Johns Hopkins Peripheral Nerve Center (hopkinsmedicine.org) 
5. Milind Y. Desai, MD, MBA, FACC. Radiation Associated Cardiac Disease Jun 21, 2017. American College of Cardiology. Retrieved from https://www.acc.org/latest-in-cardiology/articles/2017/06/13/07/13/radiation-associated-cardiac-disease
6. Mark P Little, senior investigator; Tamara V Azizova, head of department; David B Richardson, professor et al. Research- Ionising radiation and cardiovascular disease: systematic review and meta-analysis. BMJ 2023; 380:e072924 doi: https://doi.org/10.1136/bmj-2022-072924 (Published 08 March 2023)  
7. Pacheco, R., Stock, H. Effects of Radiation on Bone. Current Osteoporosis Report 11, 299–304 (2013). https://doi.org/10.1007/s11914-013-0174-z 
8. Okoukoni, C., Farris, M., Hughes, R.T. et al. Radiation-Induced Bone Toxicity. Current Stem Cell Reports 3, 333–341 (2017). https://doi.org/10.1007/s40778-017-0099-z 
9. Harvard Health Blog. Charlie Schmidt, Editor. New study compares long-term side effects from different prostate cancer treatments. February 27, 2020. Harvard Medical School Annual Report on Prostate Diseases retrieved from https://www.health.harvard.edu/blog/new-study-compares-long-term-side-effects-from-different-prostate-cancer-treatments-2020022719009 
10. Dario Pasalic, MD; Daniel A. Barocas, MD, MPH; Li-Ching Huang, PhD et al. Five-Year Outcomes From a Prospective Comparative Effectiveness Study Evaluating External-Beam Radiotherapy With or Without Low-Dose-Rate Brachytherapy Boost for Localized Prostate Cancer. DOI: 10.1002/cncr.33388, Published online February 17, 2021 in Wiley Online Library (wileyonlinelibrary.com) retrieved from https://www.vumc.org/prostate-study/sites/default/files/public_files/2021.06%20-%20Cancer%20%28Five-year%20outcomes%20brachy%29.pdf 
11. M. Shayne Gallaway, PhD, MPH; Julie S. Townsend, MS; Daniel Shelby, BS et al. Pain Among Cancer Survivors. ORIGINAL RESEARCH — Volume 17 — July 9, 2020. Retrieved from https://www.cdc.gov/pcd/issues/2020/19_0367.htm 
12. Changchuan Jiang, MD, MPH; Haowei Wang, BS; Qian Wang, MD, MPH, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States. JAMA Oncol. 2019;5(8):1224-1226. doi:10.1001/jamaoncol.2019.1439. Retrieved from https://jamanetwork.com/journals/jamaoncology/fullarticle/2736363 
13. Fatigue in Long-Term Cancer Survivors. ONCOLOGY Nurse Edition. August 3, 2009. Vol 23 No 8. Retrieved from https://www.cancernetwork.com/view/fatigue-long-term-cancer-survivors 
14. Fatigue| Survivorship | City of Hope. Retrieved from https://www.cityofhope.org/patients/survivorship/physical-health-and-wellness-after-cancer-treatment/after-treatment/fatigue