After Cancer Treatment Survivorship Program
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Oncology Referrals
Life after cancer is filled with many questions and uncertainties. The After Cancer Treatment Survivorship program at the Hyundai Cancer Institute at CHOC consists of a multidisciplinary team that provides comprehensive follow-up visits to evaluate your overall health concerns. Our specialists will also educate you and your family about the long-term effects of cancer treatment, fertility issues, education, employment rights and more.
At CHOC, we welcome all pediatric cancer survivors to participate in our survivorship program, even if you received cancer treatment elsewhere.
A Complete Approach to After Cancer Treatment Survivorship
The After Cancer Treatment Survivorship team is committed to ensure that you recover to your fullest after your diagnosis. We understand that a cancer diagnosis is disruptive, and that you and your family are defining your “new normal.” At CHOC, we also want to make sure you’re equipped with resources and answers to questions about life after cancer.
We provide the following comprehensive services to our survivors:
Creating a Wellness Plan
- Guidance on how to define your “new normal”
- Diet and nutrition
- Exercise and other physical activity
- Coping with fatigue
- Managing stress and worry
- Communicating your cancer experience with family and friends
- Psychological and psychiatric care referral
- Support group and patient/family education sessions
Monitoring for Late Effects of Treatment
Most survivors of cancer will have at least one long-term side effect of their cancer or their cancer treatment. Surgery, chemotherapy and radiation therapy may cause issues in different areas and we can help monitor:
- Heart
- Lungs
- Endocrine system (hormones)
- Bone growth and strength
- Mouth (teeth and gum) health
- Eyes
- Cognitive function, such as memory, processing and concentration changes
- Cancer recurrence or development of a second cancer
- Treatment with primary care and specialty care providers, including transition to a primary care provider when appropriate
- Hearing
Learn more about the late effects of cancer treatment.
Management of Physical Changes
- Integrative health therapy
- Nutrition services
- Prosthetic management
- Pain management
School Re-integration/Re-entry
- School personnel and peer education
- Evaluation of cognitive function
- Individual Education Programs (IEP)
- 504 Plan
Personalized Treatment Summary and Notebook
It can be overwhelming to transition to life after cancer. We recommend keeping an organized summary of your treatments, so that it can easily be shared with other doctors. The necessary information related to your survivorship includes:
- Type of cancer
- Type and dates of treatment provided
- Results of key laboratory reports and scans
- Side effects and major complications experienced
- The number and/or title of any clinical trial participation
- Name(s) and contact information for your cancer care provider
Learn more about cancer support services at CHOC.
A Team Approach for a Healthy Life After Cancer
Depending on the after-effects of your treatment, your appointments may include CHOC experts from our many other specialties such as neurology, orthopaedics, endocrinology, gastroenterology, hematology and more.
Your CHOC cancer survivorship team will also include respiratory therapists, nurses and nurse practitioners, social workers, psychologists, rehabilitation therapists, dietitians, pharmacists, speech and occupational therapists and child life specialists, as needed.
Beyond the clinic, we also provide educational workshops and seminars for our teen and young adult cancer survivors. Our goal is to provide survivors with the tools they need to advocate for themselves.
Some cancer treatments like surgery, chemotherapy or radiation can cause long-term side effects years later. Learn more about the potential after effects from treatment, and the CHOC specialists who are experts in those areas that can help manage your child’s health.
Audiology
If you experience problems with hearing after getting cancer treatment, you will be referred to an audiologist – a specialist trained to evaluate and treat problems with hearing, balance and other auditory disorders, or an otolaryngologist – a specialist trained focused on ears, nose, and throat surgery and medicine.
Ototoxicity is when cancer treatments cause hearing or ear function problems.
Chemotherapy and radiation treatments that can cause ototoxicity include carboplatin and cisplatin.
Potential late effects of treatment include: hearing loss, ringing in your ears (tinnitus), a sense that you are moving when you are not (vertigo), or hardening of the tissues in your ear (tympanosclerosis or otosclerosis).
Cardiology
If you experience any problems with your heart function after getting cancer treatment, you will be referred to a cardiologist – a specially trained doctor to evaluate and treat problems with how your heart works.
Cardiac toxicity is when cancer treatments causes heart problems. Chemotherapy and radiation treatments that can cause cardiac toxicity include anthracycline agents like daunorubicin, doxorubicin and mitoxantrone.
To reduce the damage that chemotherapy can cause, you may have been given a “cardio-protectant” like dexrazoxane (also known as Zinecard®). Even if you were given this drug, your heart may have still been damaged.
Potential late effects of treatment include:
Enlarged heart (cardiomyopathy)
Abnormal rhythm of your heart beat (arrhythmias)
Changes in how your heart pumps blood to your body (left ventricular dysfunction)
Changes to how your body is able to move blood through your body (carotid artery disease, subclavian artery disease, congestive heart failure)
Painful heart movement (pericarditis)
Changes to how blood flows through your heart (pericardial fibrosis, valvular disease, atherosclerotic heart disease).
In rare cases, your heart may have been damaged to such an extent that you are at higher risk than others for heart attack (myocardial infarction).
Other conditions, such as a high lipid level in your blood (dyslipidemia) and high blood pressure (hypertension), can affect how well your heart works. If you are overweight, your heart can also have problems with normal function.
Your heart function can also be influenced by how your kidneys work. Therefore, if you are receiving treatment for your kidneys then you may also receive treatment for your heart.
Endocrinology
If you experience any problems with your endocrine system after getting cancer treatment, you will be referred to an endocrinologist – a specialist trained to evaluate and treat problems with the endocrine system.
The endocrine system is made up of a lot of different glands in your body that communicate through special chemicals called “hormones.” Potential late effects of treatment are quite varied given the big role that the endocrine system plays in your body. Some problems you can experience include:
Difficulties with having babies in the future (infertility)
Changes in how you grow
Reduced bone mineral density, putting you at risk of having bone fractures
Challenges in maintaining a healthy weight
Changes in your period
Feelings of extreme tiredness
Problems feeling too cold or too hot
Dry skin or brittle hair
Changes in your sexual development and function
Problems with blood sugar (diabetes) or blood lipid levels (dyslipidemia)
Changes to the rhythm and speed of your heartbeat
Problems with eye or other motor movement
Gastroenterology
If you experience any problems with your gastrointestinal (GI) tract after getting treatment for cancer, you will be referred to a gastroenterologist – a specialist trained to evaluate and treat problems with the stomach, intestines, esophagus, liver, pancreas, colon and rectum.
Some treatments can cause problems with your gastrointestinal (GI) tract or liver. Chemotherapy treatments that can cause problems with your liver include mercaptopurine (6MP), thioguanine (6TG), and methotrexate. Radiation therapy and bone marrow/stem cell transplantation can also change how your liver works.
Radiation therapy can also change how your esophagus (the tube from your mouth to your stomach) and intestines or bowel works.
Potential late effects of treatment include changes in how your liver or gallbladder works, difficulty swallowing (dysphagia) or narrowing of your GI tract, development of heartburn, or problems with constipation or diarrhea.
Depending on your treatment and family history, you may be at higher risk of developing colon or colorectal cancer in the future. If you are told that you are at increased risk, screening for these cancers will start sooner for you than for others your same age.
Gynecology – Female Reproduction and Sexual Health
If you experience any problems with your reproductive tract after getting treatment for cancer, you will be referred to a gynecologist – a specialist trained to evaluate and treat problems with female reproduction and sexual function.
Chemotherapy treatments that can interfere with normal ovarian function include alkylating agents (busulfan, cyclophosphamide, ifosfamide and lomustine), heavy metal agents (carboplatin and cisplatin) and other drugs like dacarbazine and temozolomide.
Radiation therapy can also change how your ovaries may work in the future. It can also cause hardening of the tissues of your reproductive system.
Potential late effects of treatment include changes in how you grow and mature, fluctuations to the cycle of your period, sexual dysfunction, pelvic pain and difficulties having children in the future.
Depending on your treatment and family history, you may be at higher risk of developing cervical cancer in the future. If you are told that you are at increased risk, screening for this cancer may start sooner for you than for others your same age.
Male Reproduction and Sexual Health
Some treatments can cause problems with the urinary and reproductive tract in boys and young men. If you experience these problems, you will be referred to a urologist – a specialist trained to evaluate and treat problems with male reproduction and sexual function.
Chemotherapy treatments that can interfere with normal testicular function include alkylating agents (busulfan, cyclophosphamide, ifosfamide and lomustine), heavy metal agents (carboplatin and cisplatin) and other drugs like dacarbazine and temozolomide.
Radiation therapy can also change how your testicles may work in the future.
Potential late effects of treatment include changes in how you grow and mature, sexual dysfunction and difficulties having children in the future.
Depending on your treatment and family history, you may be at higher risk of developing testicular or prostate cancer in the future. If you are told that you are at increased risk, screening for these cancers may start sooner for you than for others your same age.
Ophthalmology
Some treatments can cause problems with vision and how your eyes should work. If you experience any problems with your sight after getting treatment for cancer, you will be referred to an ophthalmologist – a specialist trained to evaluate and treat problems with your eyes and your vision care.
Chemotherapy treatments that can cause changes to your eye function include the use of busulfan and steroids like dexamethasone and prednisone. Radiation therapy can also change how your eyes function if your eyes were part of the treated area. If you had eye or brain surgery as part of your treatment, it is also possible that you will experience vision deficits.
Potential late effects of treatment include clouding of the lens in your eye (cataracts), changes to your vision, dry eye, chronic eye irritation or pain, excessive tearing, light sensitivity and poor night vision.
Pain Management
Cancer treatment can result in chronic pain as a result of chemotherapy, radiation, other cancer treatments or surgery that you had. If you experience any problems with pain after getting treatment for cancer, you will be referred to a pain management specialist who is trained to evaluate, treat and manage your pain. Rehabilitation, neurology or psychology specialists can also help manage your pain.
Chemotherapy treatments that can cause changes to how your nerves work include carboplatin, cisplatin, vinblastine and vincristine. Steroid treatments, such as dexamethasone and prednisone can change the structure and function of your joints making it more painful to move.
Radiation therapy can change the structure of your bones, making it more painful to move or putting you at higher risk of having a bone fracture in the future.
Bone marrow/stem cell transplantation can cause future joint or bone pain.