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Long Term Effects of Chemotherapy

Ears/Hearing

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.

Heart

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.

Lungs/Pulmonary

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.

Liver

Cancer Therapy: long-term use of methotrexate

Effects: hepatotoxicity, cirrhosis, fibrosis, chronic liver disease

Recommendations: elicit history and assess liver function

Gastrointestinal Tract

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.

Genitourinary System

Cancer Therapy: cisplatin, mitomycin, nitrosoureas, ifosfamide

Effects: decreased creatinine clearance, hypomagnesemia, and renal tubular acidosis

Recommendations: monitor urinalysis, creatinine clearance and blood pressure

Bladder

Cancer Therapy: cyclophosphamide, ifosfamide, cisplatin, nitrosoureas

Effects: hematuria, pyuria, dysuria, increased frequency of voiding, urinary incontinence

Recommendations: urinalysis, urine for cytology, voiding cystourethogram

Gonads/Reproductive Function

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.


© 2013 The University of Texas MD Anderson Cancer Center