Information on popular complementary and alternative medical topics

“Late effects” and “aftereffects” are terms used interchangeably to describe any changes or problems that occur after completion of cancer treatment and are due to your cancer or to the treatment you received. These changes and problems can occur weeks, months, or many years after completion of cancer treatment. Technically, there are four different types of aftereffects:

•Delayed effects are expected changes that are measurable weeks to months after cancer treatment. Examples of delayed effects include persistent anemia, fatigue, and anxiety following chemotherapy.

•Delayed complications are problems that occur only sometimes and appear weeks to months after cancer treatment. Examples of delayed complications include radiation pneumonitis (lung inflammation from radiation), infection related to persistent low blood counts following chemotherapy, and a severe anxiety disorder following any cancer treatment.

•Late effects are expected changes that are measurable months to years after cancer treatment. Examples include skin changes following radiation that allow easy sunburn and early menopause following chemotherapy.

•Late complications are problems that occur only sometimes and first appear months to years following cancer treatment. Examples include bowel obstruction from radiation-induced scarring in the abdomen and the development of a second cancer following bone marrow transplantation.

Be sure what definitions are being used when you read or hear about posttreatment problems.

Compared with what we know about the immediate medical effects of cancer treatment, we have relatively little information on its late effects. This is because long-term survivorship is a relatively new phenomenon. However, interest in the field is growing fast. Many studies are under way that promise to provide valuable information about the prevention, diagnosis, and treatment of late effects.

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How Does Chemotherapy Affect the Skin?

Chemotherapy can affect the skin by

• causing direct changes in the skin cells

• causing changes to blood vessels under the skin

• exacerbating preexisting skin conditions

• allowing skin infections to develop that are normally prevented by a healthy immune system

How Does Radiation Affect the Skin?

Radiation can affect the skin by

• causing changes to exposed skin

• causing changes to the blood vessels under the skin

If I Have Skin Changes from My Radiation, How Long Will They Last?

Skin changes that can occur during and soon after radiation include

• redness

• sensitivity or discomfort •warmth

• blisters

• skin breakdown

How long the skin changes last will depend on

• the area radiated (the back, the armpit, the groin, and the hands are more sensitive to the changes of radiation)

• the total dose of radiation received

• the type of radiation received

• previous surgery or concomitant chemotherapy

• infection

What Are Late Skin Changes of Radiation?

Changes in the skin that occur months to years following radiation include

• thinning of the skin

• contracture (tightening) of the skin

• telangiectasia (tiny red blood vessels seen on the skin)

• darkening or lightening compared to nonradiated skin

• problem with trauma-induced bruising or tearing

• slower, poorer healing after surgery or cuts

What If My Skin Is Dry?

After cancer therapy your skin may be dry because of

• injury, permanent or temporary, to the oil apparatus of the skin

• sensitivity to drying agents (water, soaps)

What Is Radiation Recall?

Radiation can cause permanent, if invisible, changes in the radiated skin, such that when you receive chemotherapy the area of skin previously radiated develops a reaction. If you received radiation to your shoulder, and years from now you took chemotherapy, you would have a chance of developing a reaction in the skin overlying your shoulder. This would depend on how much radiation you received, the chemotherapeutic agents used, and other factors, as yet unclear.

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It is important that you keep your doctors informed about your energy level. Describe in concrete terms how tired you are: “When I sit down to dinner, I’m too exhausted to lift the fork to my mouth,” “After I get my kids ready for school, I have to lie down,” or “I’m fine when I get to work, but by eleven I can’t concentrate and need to close my eyes.”

Describe the pattern of your fatigue: how often it occurs, when it occurs, how severe it is, what triggers or aggravates it, what prevents or alleviates it, and what the overall trend is (e.g., getting worse or better the past few weeks, the same as it has been since treatment ended). Is it worse in the morning or the afternoon? When you are hungry or full? When you do or do not get exercise? On workdays or schooldays or weekends?

Explain to your doctor how your energy limitations are affecting you on a practical level. A single mother of two young children may be unable to take care of them because of her fatigue, or she may be unable to get the rest she needs to offset the fatigue. In contrast, a widowed grandmother may be able to satisfy her physical and emotional needs by adjusting her daily schedule to accommodate her slowed pace and increased need for sleep.

Your doctor also needs to know how you are being affected emotionally. Do you fear that the fatigue indicates persistent or recurrent cancer? Is your inability to do what you want or need to do making you feel depressed? Is it causing problems at work or home?

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Feeling whole is a state of mind. If you see yourself as whole, you are whole. An important means to this end is to recognize what makes you “you.” Your essence goes far beyond job, clothes size, and talents. Self-reflection, discussion with family, friends, support people and groups, and professional counseling can help you discover or rediscover who you are.

If you have suffered a loss that strips you of your livelihood, hobbies, or usual means of communication or mobilization, you may have to change your definition of yourself. Your losses may allow you to see and develop strengths and abilities you never appreciated or knew you had.

If you have sustained a physical loss, there are healthy ways to adjust and compensate:

•Gather facts. Find out as much as you can about treatment options for your problem.

• Find out whether surgery or mechanical devices are available to repair or compensate for the

lost part or function.

• If the loss is permanent, learn as much as you can about how to cope with it. Find support

groups specific to your needs. No matter how devastating your physical losses, other people

Your children will tell you how much they can handle. Pay attention to their body language, comments, and questions to gauge their readiness for a topic. If they are fidgeting, avoiding eye contact, changing the topic, or trying to leave the room, they are telling you that they are not ready to talk about the topic.

Answer questions as simply and directly as possible. In general, the simpler your answers, the better. You can always elaborate if they ask for more.

Stay accessible so that information, comfort, and reassurance are provided when they most need it. Keep the other significant people in your children’s lives involved. Teachers, clergy, friends’ parents, coaches, grandparents, and neighbors are all in a strategic position to provide you with feedback on how your children are doing and to reinforce your communications.

Ideally, news and problems should be presented by you or your spouse, or both. If you are sobbing uncontrollably, your children will be afraid no matter how perfect your choice of words. Simple crying or teariness is appropriate; it teaches them that this is difficult for you and that it is normal and healthy to have and show emotions. Explain your tears: “Mommy is sad about having to go into the hospital for tests, but I’m ready to do whatever I need to do to stay healthy.” “Daddy is sad about my headaches, but the doctors are going to find medicines to make them go away.”

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