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Care During Chemotherapy and Beyond

Late Effects of Chemotherapy Treatments in Childhood, Adolescent, and Young Adult Cancer Survivors



Late effects is a term used to describe a broad range of persistent adverse effects related to the disease process, its therapy, or both.  The onset may be unpredictable (months or years after completion of therapy).

It is estimated that while most childhood cancer survivors enjoy good health, at least 40% have significant disabilities that affect their quality of life.

Factors associated with the development of late effects

  • location and extent of primary disease
  • type and intensity of the initial treatment
  • age and physiological and developmental status of child at the time of diagnosis and treatment
  • genetic or familial predisposition that may interact with treatment-related  injuries

Categories of Late Effects

  • Physical: all systems of the body can be affected; secondary cancers
  • Emotional:  psychological, social adjustments, and academic difficulties
  • Economic:  financial and uninsurability concerns and employment issues

The High-Five Clinic

The High-Five Clinic at the Cleveland Clinic Children's Hospital-so named because patients must be five years past diagnosis, and off treatment for two years without relapse, offers guidance in dealing with long-term survival issues such as chemotherapy late effects. An extensive questionnaire is sent in advance of the patient's visit. This allows clinic staff to target areas of concern and schedule appointments with other specialists, a psychologist or a financial counselor on the same day.

At the appointment, a careful history is taken and a physical examination is performed. Time is allocated to discuss concerns, problems and risks. Following the visit our staff compiles a comprehensive summary detailing therapies the patient received, risk factors for future problems, and necessary referrals, testing and future studies. This is mailed to patients to discuss with their physicians.  The result is a young adult equipped to inform future providers about their history, and their ongoing concerns such as chemotherapy late effects.  Pediatricians, Family physicians, and internists find it useful to have relevant information. 

The High Five Clinic is proud to have sponsorship from the Scott Hamilton Fund. 

To learn more about the High-Five Clinic, click here.
To learn more about the Children's Hospital at the Cleveland Clinic, click here

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.