After Treatment

After treatment for ALL ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for cancer, including ALL, should have life-long, follow-up care.

Based on the type of treatment the child received, the doctor will determine what examinations and tests are needed to check for long-term side effects, such as learning disabilities, depression, anxiety, post-traumatic stress disorder, bone and joint damage, and the possibility of secondary cancers. Your child’s doctor can recommend the necessary screening tests. Follow-up care should address the child’s quality of life, including any developmental or emotional concerns. Learn more about Childhood Cancer Survivorship.

For the majority of childhood ALL survivors, there are relatively few significant long-term side effects. A recent study demonstrated that patients who did not receive radiation therapy and have been in remission at least 10 years were similar to the general population in terms of rates of health-care coverage, marriage, and employment. Survivors should be sensitive to their level of functioning and level of stress, and they may need counseling if any problems arise. It is important that children with school problems undergo neuropsychological testing in order to determine the cause. Tutoring in academic subjects or providing help in achieving appropriate organizational skills is very important since many problems are correctable with help. Survivors should also be evaluated for bone or joint pain as it may be caused by treatment-related destruction of the bone.

If a child did not receive radiation therapy and intensive chemotherapy with cyclophosphamide (Cytoxan, Neosar) and/or etoposide (VePesid, Etopophos, Lastet), secondary cancers and infertility (the inability to have children) are rare. Also, future heart problems are rare, as the total dose of anthracycline (a type of antibiotic) given in the majority of pediatric ALL clinical trials is less than 250 mg/m2. Although the risk to any one individual is small, radiation therapy increases the risk of secondary brain tumors, as well as the risk of learning disabilities.

Patients should receive follow-up screening at gradually increasing intervals to monitor for:

• Recurrence (rare after the end of the second year), after chemotherapy is completed
  
  
• Liver disease, caused by chemotherapy or transfusion-related infection (both very rare)
  
  
• School problems (as described above)
  
  
• Problems related to obtaining insurance coverage

Note that much of the data used to demonstrate that childhood cancer survivors are good candidates for insurance will come through the collection of long-term, follow-up data on survivors.

The child’s family is encouraged to organize and keep a record of the child’s medical information, so that as the child enters adulthood, he or she has a clear, written history of the diagnosis and details of the treatment given. The doctor’s office can help you compile this, and it should include recommendations from the doctor about the schedule for follow-up care. This information will be valuable to doctors who care for your child during his or her lifetime.

Children who have had cancer can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment.