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Late Effects of Treatment

Medical treatment of young people with cancer improves every year. More and more are surviving, progressing through school, and entering adulthood.

Follow-up

Parents, the medical team, teachers, and other educational professionals, need to be aware that there may be late effects of the medical treatment of childhood cancer and be ready to follow up with strategies to encourage the student in overcoming any learning disabilities.

Chemotherapy and radiotherapy will damage normal cells as well as cancerous ones – some children will recover all function completely but others may have problems.

You may come across students who were treated for cancer as preschoolers or many years ago and it is important that schools are passing this knowledge on to subsequent learning institutions as the problems may not be apparent for many years.

Late effects to be aware of

Cranial irradiation, given for brain tumours and some high risk forms of leukaemia, carries an increased risk of learning problems. Some children have shown significant declines in IQ (10-20 points) and other academic achievement tests. Specific deficits that have been identified are in visual motor integration, memory, attention and motor skills. Nonverbal skills e.g. abstract reasoning, visual spatial skills and mathematics are especially vulnerable to cranial irradiation and intrathecal chemotherapy.

Common learning difficulties may be expressed as problems with:

  • Reading (and comprehension)
  • Spelling
  • Handwriting (unable to write accurately or quickly)
  • Mathematics with concepts requiring short-term memory such as “times tables”
  • Attention span or concentration. Children may become hyperactive or inattentive
  • Short term memory-storage of new information and retention of material

It is advisable that all children who have had these treatments have annual neuropsychological evaluations.

Often the learning deficits will increase over time but, with good assessment and appropriate intervention, the impact on learning can be minimised.

Long term physical side effects

Other physical problems that may be long term side effects of treatment for childhood cancer include abnormal hormone function leading to growth retardation and early or late puberty, hearing damage, infertility, heart damage, lung problems, dental problems, kidney problems and eye problems. All of these will need monitoring and may need further treatment. It is important that if the school notices a problem this is communicated to the child’s parents.

Survivors of childhood cancer may have an increased risk of having further malignancies - learning to live with the worry of disease recurrence and of developing another cancer is another burden for these children and their families.

Risk of Psychological problems

Recent research has shown that survivors of childhood cancer are at substantially greater psychological risk than survivors of other chronic but non life-threatening illnesses. Siblings of children with cancer are also at increased risk of psychological problems. Being aware of this may alert you to any changes in behaviour. Again, early assessment and intervention may minimise these problems.

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