Late Side Effects from Chemotherapy

Childhood cancer survival is one of the greatest success stories of medicine in recent years. Since the 1970's, the cure rate and number of survivors has grown dramatically. As the number of survivors of childhood cancer continues to grow, so does knowledge of the late effects of cancer treatment.

More than two-thirds of young adult survivors of childhood cancer eventually experience at least one "late effect," with some survivors experiencing more. Late effects can occur in any organ or system of the body and vary from person to person.

In this segment, Bob Hayashi, MD., discusses late side effects of chemotherapy and when to refer to a specialist in this program at SLCH.
Late Side Effects from Chemotherapy
Featured Speaker:
Bob Hayashi, MD
Dr. Hayashi is Director of the Division of Pediatric Hematology/Oncology and an attending physician in Hematology/Oncology and General Pediatrics at St. Louis Children's Hospital. His research interest focuses on issues related to long term effects of cancer therapy. His efforts examine the nature and spectrum of clinical conditions affecting childhood cancer survivors with the goal of developing interventions to improve the outlook of this patient population. He directs The Late Effects Clinic at St. Louis Children's Hospital providing comprehensive care for patients afflicted with a broad scope of conditions.

Learn more about Bob Hayashi, MD

Melanie Cole (Host): Childhood cancer survival is one of the greatest success stories in medicine in recent years. Since the 1970s, the cure rate and number of survivors has grown dramatically. As the number of survivors of childhood cancer continues to grow; so does knowledge of the late effects of cancer treatment. My guest today is Dr. Robert Hayashi. He's a professor of pediatrics and a Washington University pediatric hematologist and oncologist at St. Louis Children's Hospital. Welcome to the show Dr. Hayashi. Explain a little bit about some of the late side effects from chemotherapy. What are these? What are some of the consequences of chemotherapy that you might notice later?

Dr. Robert Hayashi, MD (Guest): So, as you had mentioned this success rate of child cancer has been a great story, but it has come at a price. So, every cancer treatment has its own side effects. Some of the side effects go away with time but some of them persist or can have the potential to even get worse and we call these side effects, late effects and we know that late effects of cancer therapy can affect children in many ways. It can affect them physically, with the therapy affecting different organ functions. It can affect their intellectual function and their performance in school and it can even affect them emotionally in terms of their emotional state as they get older, how they interact with their peers, how they interact with their families and our program really wants to provide the care for the entire patient and support each of these issues as they develop as a child gets older.

Melanie: Are there certain things that can affect a child's risk of late side effects? Are there some predispositions for some of these?

Dr. Hayashi: The risk of different late affects is strictly dependent upon the type of therapy that the patient received and so central to our management of these patients is to generate what we call treatment summaries for the families. This outlines the exact therapy that a child received. It could be surgery, it could be chemotherapy, it could be radiation therapy. It gives very specifics on that therapy so that the family can share them with other physicians. But then taking that profile of therapy; we then outline the specific risk factors of the late effects that a particular patient may experience based upon that treatment experience.

Melanie: So give us a little example of that and some complications of the late side effects if left untreated like fertility preservation for pediatric cancer patients, along those lines.

Dr. Hayashi: Right, so there are many different late effects but fertility preservation is certainly one of them. Both radiation and chemotherapy can have problems affecting a child's ability to have children as they get older. Some of these things develop slowly. Some of them occur quite quickly. So central to our management of the patients; is that we provide education in terms of what they can expect. We provide opportunities to try to preserve fertility which may even include sperm banking or egg harvesting even before the treatment starts. But if we encounter a child who has already received treatment; we use their treatment summary to characterize what the risk for fertility loss will be and then we have discussions with the families of what would be the appropriate measures to take and when would be the appropriate time to take those measures, so that a family can make educated decisions and ideally preserve the fertility for the child, so that they can have children when it is an appropriate time to do so.

Melanie: Dr. Hayashi, how important is early diagnosis of these late side effects as being crucial to improve outcome predictions? Can some of these effects be prevented, controlled or improved if they're anticipated and detected early enough?

Dr. Hayashi: I think central to the management of these patients is patient and family education. A family needs to have an understanding of what these risk factors are. We make an effort at St. Louis Children’s Hospital to provide this education right from the very first day the child is diagnosed that the family can build on that education and be aware of the late effects as they may or may not develop over the course of child's treatment and obviously beyond. As they acquire more information, they realize and become more acquainted about what the specific difficulties their individual child will have and then we counsel them in terms of what kinds of things they can do to minimize further damage to preserve as much function as possible. So, it's really a partnership between you know our late effects team and the patient of families. But it's really a lifelong commitment. This is something that will continue to evolve as the child gets older and we need to both stay in touch with the family so that we can educate them to the issues as they develop, to keep them up to date with the latest research discoveries and also link them with services that will assist them as they start to manifest more problems.

Melanie: So tell us about the late effects program in St. Louis Children's Hospital.

Dr. Hayashi: The Late Effects Children's Hospital Program has been in existence now for over fifteen years. It's a multidisciplinary program in which we bring all our experts together to provide the best care and comprehensive care for the patient and families. We have practitioners, we have psychologists, we have social workers, we have child life therapists, we have physical therapists, audiologists, occupational therapists and school liaisons. So, we can provide a full comprehensive management care for the patient which will be tailored to that individual patient’s needs and they will follow the patient into adulthood to ensure that they can reach each milestone, that they can succeed in school, they can succeed in college and make the appropriate transitions to a healthy adult life so they can achieve their long term goals of employment and raising a family and so this is a commitment that we feel very strongly about and we've been able to create a very successful comprehensive program in our institution.

Melanie: And what would you like other pediatricians to know about these late side effects from chemotherapy and when to refer and also, Dr. Hayashi, what to be looking for as they are doing their well-visits and their vaccinations and their you know their regular scheduled visits with their pediatric cancer patients; that they're going to see separate from you? What would you like them to know about things they should be on the lookout for and on the watch out for?

Dr. Hayashi: Well I think it's very difficult for the general pediatrician to really maintain awareness of the scope of late effects that our patients experience. First of all, this is a very dynamic field. Late effects research is relatively young and so we're learning new things every day and so it would be not practical for the average pediatrician to stay on task with regard to those discoveries. Our recommendation is that if a patient has a cancer diagnosis; even if it would appear that the treatment was trivial, it's important that they get a linked to a late effects program that we can provide a treatment summary and provide a strategy in terms of how to follow the patient long term; both to be able to recognize the late effects as they occur but also to link them with the appropriate treatments and hopefully we can develop strong partnerships with our community pediatricians so that we can work together to provide the best care we can for the patient.

Melanie: And what can a physician expect from your team after referral in so far as communication with the referring physician and your team approach?

Dr. Hayashi: So we would expect to be able to deliver to the referring pediatrician a treatment summary that would be the same document that the family would receive, so they can follow along with us in terms of the different issues that may manifest themselves and what things that the family needs to watch for, what things would require further evaluation and what things they can do to maintain their wellness to optimize each late effect to minimize their impact on the child’s life. And obviously we maintain constant communications with the referring physician so that they're aware of all of the changes in status and all the updates that they need for to maintain the optimal care for the child.

Melanie: Thank you so much for being with us today. A physician can refer a patient by calling Children's direct physician access line at 1-800-678-HELP. That's 1-800-678-4357. You're listening to Radio Rounds with St. Louis Children's Hospital. For more information on resources available at St. Louis Children's Hospital you can go to StLouisChildren' That's StLouisChildren' This is Melanie Cole. Thanks so much for listening.