Late effects after childhood cancer: what parents need to know

Children who have been treated for cancer are still growing and developing, so chemotherapy, radiotherapy, surgery and stem cell transplant can affect them in ways that may not show until years or decades later. Many childhood cancer survivors grow up healthy and lead full lives, but most will have at least one late effect at some point, ranging from mild to more significant. The effects that matter most depend on the child's age at treatment, the type of cancer, the medicines and total amounts received, whether radiotherapy was given and to which areas, and whether a transplant was needed. This is why lifelong follow-up, matched to each child's treatment, is recommended by international guidelines.

Common areas of concern include growth and puberty, especially after radiotherapy to the brain or spine or high-dose treatment; fertility, after alkylating medicines, pelvic radiotherapy or transplant; learning, memory and attention, particularly after brain radiotherapy or methotrexate into the spinal fluid; the heart, after anthracyclines such as doxorubicin or chest radiotherapy; hearing, after cisplatin or carboplatin and radiotherapy near the ears; kidneys, after cisplatin, ifosfamide or kidney surgery; the thyroid, after neck radiotherapy; teeth, eyes and bones; and emotional wellbeing. There is also a small increased risk of second cancers later in life, especially after radiotherapy.

Lifelong follow-up works best in a long-term follow-up or survivorship clinic, where doctors know which checks each treatment requires. Parents play a vital role: keeping a treatment summary, attending follow-up, watching growth, learning and emotional health, and gradually teaching the young person about their own history. A planned move from children's to adult care, with records going with the young person, prevents follow-up from being lost. This page explains the general picture; your child's team will advise on the checks they need.

Most survivors lead full lives

But many will have at least one late effect that benefits from monitoring.

Checks are matched to treatment

Your child's medicines and radiotherapy decide which tests they need.

Follow-up is lifelong

Some effects appear decades later, so checks continue into adulthood.

It cannot tell you which late effects your child will develop or how likely they are. That depends on their treatment, and their oncology team can advise.

It also cannot replace a personalised follow-up plan. Ask the team to create one based on your child's treatment.

Growth and learning

Children who had radiotherapy to the brain may grow less than expected because of reduced growth hormone, and may find schoolwork harder as they get older. Regular measurement, hormone tests and school assessments help. Growth hormone treatment and learning support can make a real difference.

School and education

Children often miss school during treatment and may need help catching up. Tell teachers about your child's treatment and ask for adjustments such as extra time, rest breaks or learning support. Learning difficulties may appear years after treatment, so keep watching.

Talking to your child about their treatment

As children grow, explain their cancer history in age-appropriate ways. Teenagers and young adults need to understand their treatment, the checks they need and why, so they can take charge of their own health.

Transition to adult care

The move from children's to adult services is a common point where follow-up is lost. Plan it early, make sure records go with the young person, and identify an adult doctor or clinic to continue checks.

Emotional and social wellbeing

Survivors may feel different from peers, worry about relationships or the future, or experience anxiety. Counselling, peer support and survivor groups help.

Healthy habits

Avoiding tobacco, staying active, eating well and protecting skin from the sun are especially important for survivors.

Fertility checks as children grow

Children treated with medicines or radiotherapy that affect fertility may need hormone tests around puberty and fertility assessment in adulthood. Some had fertility preservation before treatment; records of stored material should be kept safely and explained to the young person when appropriate.

Teeth and eyes

Chemotherapy and radiotherapy at a young age can affect developing teeth, causing small or missing teeth or weak enamel, and radiotherapy or steroids can cause cataracts. Regular dental and eye checks help.

Kidney and blood pressure checks

Children who had cisplatin, ifosfamide or kidney surgery may need regular blood pressure, urine and kidney tests.

Thyroid checks

Radiotherapy to the neck, brain or whole body can affect the thyroid, causing tiredness, weight gain or slowed growth. Thyroid blood tests are simple and treatment is effective.

Healthy weight and diabetes risk

Some survivors, especially after brain radiotherapy or transplant, have a higher risk of weight gain, diabetes and high cholesterol. Healthy eating and regular activity from a young age help.

Siblings and family

Brothers and sisters of children with cancer may have felt left out or anxious. Family support and counselling can help everyone adjust after treatment.

Careers and independence

Most survivors go on to study, work and live independently. Career guidance can help young people with lasting effects choose paths that suit them.

Records for young adults

Young adults should have their own copy of records to use with insurers, employers and future doctors.

Finding a survivorship clinic

Ask your child's oncology team whether a long-term follow-up clinic exists at the hospital or nearby.

What to do next

Ask for a detailed treatment summary and follow-up plan, attend long-term follow-up, watch growth, learning and mood, inform schools, plan the transition to adult care early, and teach your child about their own history.