Loss of executive function
Memory loss
Cataract
Peripheral neuropathy
Tinnitus
Deafness
Raynaud’s phenomenon
Pulmonary brosis
Ventricular failure
Coronary artery disease
Hypertension
Chronic kidney disease
Haemorrhagic cystitis
Renal tract malignancy
Infertility
Primary hypogonadism
Necrosis of femoral head
Second malignant neoplasm
Psychosocial problems
Fatigue
Osteoporosis
Principal causative drugs
1
HD = High dose
2
Topoisomerase II inhibitors
5
Multigated acquisition scan
6
SEG = socio-economic grouping
7
TYA = teenagers and young adults
3
RT = radiotherapy
4
Mini Mental State Examination
Managing those at riskRisk groups
Managing long term side eects of chemotherapy
Teenagers and young adults (TYA) who survive cancer treatment can have a range
of side eects later in life. If it is known which chemotherapeutic agents were
used, the “Principal causative drugs” column can guide monitoring and
management. Factors that further increase the risk of complications from
chemotherapy are listed in the “risk groups” section.
© 2016 BMJ Publishing group Ltd.
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Depression
Post-traumatic stress disorder
Social isolation
Strained relationships with
partner, family, and peers
Educational diculties
Employment diculties
Financial burden
MUGA
5
/echocardiogram
Consider ECG
and blood
pressure
Encourage early
presentation
Cardiac disease may
occur at much younger
ages in people who have
had chemotherapy
Advise patient to report
potential symptoms
Fertility preservation
Refer all TYA
7
undergoing
chemotherapy to fertility
preservation services
Baseline bloods
Chest
RT
Every
2 years
Every
2 years
Every
1 year
Every
5 years
Every
2 years
Every
1 year
No
chest
RT
Total anthracycline dose
(mg/m
2
)
< 200 > 300200–300
Every year
Men
Testosterone
Women
LH FSH Oestradiol
Hormone
replacement
Every
year
Full blood count
Clinical examination
Refer for MRI
Every year
Blood pressure
Every
year
Urinalysis
Every
year
Psychosocial
assessment
Every
year
Aer thoracic
radiotherapy
Baseline
MMSE
4
Consider
referral to:
Social worker
Psychologist
Occupational therapist
with school/ university/
place of work
Consider:
Neurorehabilitation
Psychotropic drugs
Rule out
reversible causes
Advise short
bursts of exercise
Screen for
underlying depression
Support
groups
Psychology
referral
Antidepressants
Assess impact on
family members
and carers
Anxiolytics
Neurological examination
Every year for
rst 3 years
Aer this, reassess
if symptoms change
Funduscopy
Every
year
Baseline
audiological
assessment
Repeat if
symptoms
Repeat if
symptoms
Refer to ENT
specialist
if changes
Consider:
Hearing aid
Assessment of reversible causes
Speech therapy
Warm gloves in winter
Baseline
tests
Respiratory
examination
Calcium channel blockers
Chest radiograph
Lung function
Vaccinations
Influenza
Pneumococcal
Every
year
Encourage self reporting
Baseline
urea and
electrolytes
Repeat if symptoms or
signs of renal failure
Refer to renal
specialist
if deterioration in
symptoms or results
Bone density scan Rule out hypogonadism
Calcium and vitamin D according to results
if clinical suspicion
Refer to ophthalmology
if symptoms
for t-AML survivors
Every
year
Mammogram
Breast MRI
from 8 years aer RT / age 25
(whichever is later)
Every
year
from puberty
to age 25
Every 6
months
aer age 25
Clinical breast exam
Encourage
communication
+
Oer
advice
Against
smoking
Respiratory
specialist
review before
anaesthesia or
SCUBA diving
Breast self-exam
Every
month
Smoking
Diabetes
High
cholesterol
CVS risks
Mediastinal RT
3
Pregnancy
High dose
Time since chemo
Older age at time of treatment
+RT
3
to gonadal region
Higher cumulative doses
High dose
Depression
CNS tumour Hearing loss Female Younger
Lower SEG
6
Learning dicultiesCranial RT
3
+RT
3
Concurrent RT
3
Concurrent RT
3
t-AML
Autologous stem
cell transplant
Concurrent
cranial RT
3
Smoking
Smoking HD
1
Younger
+RT
3
Exposure to high
O
2
concentration
Renal dysfunction
Prior renal dysfunction Diabetes
Concurrent RT
3
to urinary tract
Smoking
survivors
Enhanced
breast cancer
surveillance
Counselling
Psychosocial eects of chemotherapy include:
Other
Anthracyclines
Antimetabolites
Bevacizumab
Bleomycin
Busulfan
Cisplatin
Cyclophosphamide
Ifosfamide
Prednisolone HD
1
Taxanes
Trastuzumab
Vincristine
Vinblastine
Topo II inhibitors
2
Alkylating
agents
Possible with all chemotherapy
Most chemotherapeutic agents