Supportive care helps children and their families meet the physical, practical, emotional and spiritual challenges of cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of children living with cancer and their loved ones, especially after treatment has ended.
Recovering from leukemia and adjusting to life after treatment is different for each child, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A child who has been treated for leukemia may have the following concerns.
Learning problems
Children treated with certain chemotherapy drugs or radiation therapy to the brain may have learning problems. Generally, this is mild and does not cause any major disability. Children who are under the age of 5 during treatment may be at higher risk for learning problems.
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Hearing problems
Radiation to the brain can cause hearing loss. Younger children are at greater risk for these problems. Some chemotherapy drugs can also affect hearing.
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Heart problems
Certain chemotherapy drugs used to treat leukemia, such as doxorubicin (Adriamycin), can cause heart problems. These problems include abnormal heart beat, disease of the heart muscle and congestive heart failure. Girls treated with chemotherapy are at increased risk of late-effect heart problems.
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Lung problems
Lung problems can occur from treatment with certain chemotherapy drugs. Pneumonitis (inflammation of the lungs) is the most common lung problem caused by certain chemotherapy drugs, such as doxorubicin. The major concern of pneumonitis is the potential for it to develop into pulmonary fibrosis. Pulmonary fibrosis is the formation of scar tissue in the lungs as a result of inflammation, injury or both.
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Liver problems
Certain chemotherapy drugs, such as methotrexate, can damage the liver. The liver may become enlarged (hepatomegaly). If the liver damage increases, the liver may become hard (fibrosis) and scarred (cirrhosis).
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Reproductive system problems
Some chemotherapy drugs and radiation used to treat leukemia can cause reproductive system problems. In males, radiation therapy to the brain, head or testicles, or certain chemotherapy drugs, can cause infertility. Treatments can also change levels of testosterone and cause delayed puberty. In females, radiation therapy to the brain or head, or certain chemotherapy drugs, can cause infertility, delayed puberty, irregular menstruation and premature menopause. The higher the total dose of certain chemotherapy drugs, the greater the risk of damage. High doses of chemotherapy used in preparation for stem cell transplant increase the risk of reproductive system problems.
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Musculoskeletal problems
Children treated with radiation therapy to the central nervous system (brain and spinal cord) may be at risk for growth hormone deficiency, which can result in short stature. Children treated with radiation therapy to the brain are also at risk for osteoporosis due to low levels of sex and growth hormones.
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Second cancers
Childhood leukemia survivors are at increased risk of developing a second cancer. Radiation therapy can increase the risk of solid tumours and leukemia. Some chemotherapy drugs can increase the risk of leukemia. One of the most serious side effects of acute lymphocytic leukemia (ALL) treatment is the chance of getting a second leukemia, acute myelogenous leukemia (AML). About 5% of children develop AML after they have received certain types of chemotherapy. Less often, children treated for leukemia may later develop non-Hodgkin lymphoma or other cancers.
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See a list of questions to ask your child’s doctor about supportive care after treatment.