Long-term complications of chemotherapy

Patients with cancer are living longer and, therefore, are not only at risk for recurrence of the disease but also for long-term side effects of treatment. For patients treated with chemotherapy, secondary malignancies are a special concern, with acute nonlymphocytic leukemia being the most common. Although typically associated with alkylating agents, this complication is now being seen with use of other drugs, such as etoposide. Premenopausal women treated with chemotherapy also may be at risk for premature menopause, although there does not appear to be an increased risk for fetal malformations when conception does occur after chemotherapy. Neurotoxicity is being seen more often owing to the widespread use of cisplatin and paclitaxel. Long-term pulmonary, cardiac, and renal toxicity may be seen with drugs not commonly associated with these complications as higher-dose chemotherapy is used more frequently. When an unusual illness occurs in a cancer survivor, the possibility that it may be because of prior treatment must be considered.