Long Term Effects of Chemotherapy
Cancer therapy: cisplatin, ifosfamide, aminoglycosides
Effects: tinnitus, hearing loss; failure to follow instructions, poor school performance; decreased hearing acuity ("People don’t talk loud enough"). Damage to the outer hair cells of the cochlea is one of the major side effects of cisplatin. Middle and high-frequency range hearing thresholds are worse among children treated with combined therapy than among those receiving radiation therapy alone or cisplatin with no radiation.
Physical Findings: presence of fluid or pus behind tympanic membrane; Rhinne and Weber tests.
Recommendations: pure tone audiometry, brainstem auditory evoked response.
Cancer Therapy: anthracyclines (adriamycin or daunomycin), cyclophosphamide
Effects: pericarditis myocarditis syndrome; left ventricular failure; arrhythmias
Physical Findings: heart failure, exercise intolerance, palpitations, shortness of breath, peripheral edema, cardiomyopathy, congestive heart failure. Prior radiation therapy seems to enhance adriamycin cardiotoxicity.
Recommendations: ECG, ECHO or MUGA scan; radionuclide angiography; endomyocardial biopsy.
Cancer Therapy: alkylating agents, nitrosoureas, antimetabolites, antibiotics (especially Bleomycin)
Effects: can cause restrictive lung disease and pulmonary fibrosis
Physical Findings: shortness of breath, cyanosis, tachypnea, rales or wheezing
Recommendations: pulmonary function test with diffusion capacity/baseline every 3-5 years as needed, chest radiograph, arterial blood gases, counseling about increased risk of lung cancer in patients who received lung irradiation and who smoke.
Cancer Therapy: long-term use of methotrexate
Effects: hepatotoxicity, cirrhosis, fibrosis, chronic liver disease
Recommendations: elicit history and assess liver function
Cancer Therapy: antimetabolites such as methotrexate or cytosine arabinoside.
Effects: possible damage to the mucosal lining of cells and delayed problems with absorption and secretion.
Recommendations: elicit history for late sequelae such as malabsorption, adhesive/obstructive complictions.
Cancer Therapy: cisplatin, mitomycin, nitrosoureas, ifosfamide
Effects: decreased creatinine clearance, hypomagnesemia, and renal tubular acidosis
Recommendations: monitor urinalysis, creatinine clearance and blood pressure
Cancer Therapy: cyclophosphamide, ifosfamide, cisplatin, nitrosoureas
Effects: hematuria, pyuria, dysuria, increased frequency of voiding, urinary incontinence
Recommendations: urinalysis, urine for cytology, voiding cystourethogram
Cancer Therapy: chemotherapy (most notably cyclophosphamide, procarbazine, nitrogen mustard). ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine) may produce a more transient germ cell toxicity.
Effects in Women: menstrual irregularities, premature menopause, infertility
Effects in Men: infertility, decreased testosterone production
Recommendations: obtain menstrual history, fertility history. In younger patients perform physical exam focused on age and gender directed sexual maturation. If abnormalies are suspected, measure sex steroids and gonadotropin levels and semen analysis if appropriate.
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