The end of cancer treatment is often a time to rejoice. Most likely you're relieved to be finished with the demands of treatment. You may be ready to put the experience behind you and have life return to the way it used to be. Or you may be ready to have a fresh start at something new.

Yet at the same time, you may feel sad and worried. It can take time to recover. Many are uncertain about how to move forward, feeling anxious about the future. It's very common to be thinking about whether the cancer will come back and what happens now. Often this time is called adjusting to a "new normal." You will have many different feelings during this time.

One of the hardest things after treatment is not knowing what happens next. Those who have gone through cancer treatment describe the first few months as a time of change. It's not so much "getting back to normal" as it is finding out what's normal for you now. People often say that life has new meaning or that they look at things differently.

Your new normal may include:

• Making changes in the way you eat and what you do
• New or different sources of support
• Permanent scars on your body
• Not be able to do some things you used to do more easily
• New routines than you had before
• Emotional scars from going through so much

You may see yourself in a different way, or find that others think of you differently now. Whatever your new normal may be, give yourself time to adapt to the changes. Take it one day at a time.

Coping with Fear of Cancer Recurrence

When cancer treatment is over, patients are often faced with mixed emotions. While there is happiness and relief that come with the end of treatment, survivors may also feel fear and anxiety. Probably the most common fear is that the cancer will come back (a cancer recurrence).

Fear of recurrence is normal and often lessens over time. However, even years after treatment, some events may cause you to become worried. Follow-up visits, certain symptoms, the illness of a loved one, or the anniversary date of the date you were diagnosed can all trigger concern.

One step you can take is to be informed. Understand what you can do for your health now, and find out about the services available to you. Doing so can give you a greater sense of control.

Even though you can’t control whether or not your cancer recurs, there are steps you can take to help cope with your fears.

Talk to your health care team

• Let your health care team know your concerns. Be honest about the fears of your cancer coming back so they can address your worries. The risk of recurrence differs in each patient. Your health care team can give you the facts about your type of cancer and the chances of recurrence. They can assure you that they’re looking out for you.
• Know that it’s common for cancer survivors to have fears about every ache and pain. Talk to your health care team if you’re having a symptom that worries you. You can get advice about whether or not to schedule an appointment. Just having a conversation with them about your symptoms may help calm your fears. And, over time, you may start to recognize certain feelings in your body as normal.
• Keep notes about any symptoms you have. Also take notes about any anxiety you feel. Write down questions for your health care team before follow-up visits so you can be prepared to tell them what you’ve been going through since your last check-up or conversation.
• Talk to a counselor. If you find that your fears are more than you can handle, ask for a referral for someone to talk to. If thoughts about cancer recurrence interfere with your daily life, you might feel better seeing a counselor or therapist. A professional may help you put your concerns in perspective.
• Make sure you have a follow-up care plan. Having a plan may give you a sense of control and a way to feel proactive with your health after treatment. See the next section to learn about your plan.

Take care of your mind and body

Even though you can’t control whether or not your cancer recurs, you can use your energy to focus on wellness and manage stress. Here are some things you can do to take care of your mind and body:

• Find ways to help yourself relax. Relaxation exercises have been proven to help people with stress and may help you relax when you feel worried. Meditation and yoga also help reduce stress.
• Talk to others. Sharing your feelings with friends and family may help you feel better and realize that you’re not alone. You can also join a support group to talk to others who are having the same fears.
• Exercise. Moderate exercise (examples: walking, biking, swimming) can help reduce anxiety and depression. It also may improve your mood and boost your self-esteem.
• Eat a healthy diet. Talk to a dietician or nutritionist about the foods you should eat to stay healthy and maintain your strength.
• Write your feelings down. It may help you to express your feelings by writing in a journal or a notebook. Many people find that getting their thoughts on paper helps them to let go of worries and fears.
• Seek comfort from spirituality. Many survivors have found their faith, religion, or sense of spirituality to be a source of strength.
• Give back. Some people like to channel their energy by volunteering and helping others. Being productive in this way gives them a sense of meaning and lets them turn their attention on others.
• Take part in clubs, classes, or social gatherings. Getting out of the house may help you focus on other things besides cancer and the worries it brings.

When your treatment is finished, your doctor may tell you that you should get checkups or tests in the future. This is called follow-up care. Be sure to follow your doctor’s instructions. These tests can help find early signs of a new or the same cancer.

You can lower your risk of getting cancer again or having the cancer come back by making healthy choices like—

• Staying away from tobacco. If you smoke, try to quit, and stay away from other people’s smoke.
• Limiting the amount of alcohol you drink.
• Protecting your skin from overexposure to ultraviolet rays from the sun and tanning beds.
• Eating lots of fruits and vegetables.
• Keeping a healthy weight.
• Being physically active.
• Getting a flu shot every year.
• Getting the COVID-19 vaccine series and any booster doses to stay up-to-date.

All cancer survivors should have follow-up care. Follow-up care for cancer means seeing a health care provider for regular medical checkups once you're finished with treatment. These checkups may include bloodwork, as well as other tests and procedures that look for any changes in your health, or any problems that may occur due to your cancer treatment. These visits are also a time to check for physical and emotional problems that may develop months or years after treatment ends.

Your follow-up care plan, along with a summary of your cancer treatment, is part of what is called a survivorship care plan. This plan will have all the information for you and your doctor to discuss to ensure that you get regular and thorough care after your treatment ends.

Note that the information in this section focuses on follow-up care for your cancer treatment. But it’s important that you continue to receive your routine care from your primary care provider in addition to follow-up cancer care.

Getting a Follow-Up Care Plan

Once your cancer treatment ends, you should receive a follow-up cancer care plan from your oncologist or someone on your treatment team. A follow-up care plan is a set of recommendations for your cancer care after treatment ends. Many cancer organizations recommend the use of such a document.

For follow-up cancer care, you may see the same doctor who treated you for cancer, or you may see another health care provider, such as one who specializes in follow-up care for cancer survivors. Or you may decide to go to your primary care doctor. You can discuss which doctor(s) to see with your health care team.

Common Questions After Treatment Ends

When you receive your follow-up care plan from your doctor or other health care provider, answers to the questions below should be provided. Make sure to ask any other questions you may have:

• How long will it take for me to get better and feel more like myself?
• Which doctor(s) should I see for my follow-up care? How often?
• What symptoms should I watch out for?
• What tests do I need after treatment is over? How often will I have them?
• What are long-term health issues I might expect as a result of my cancer treatment?
• What is the chance that my cancer will return?
• What records do I need to keep about my treatment?
• What can I do to take care of myself and be as healthy as possible?
• Can you suggest a support group that might help me?

You might find it helpful to write these questions down. When you meet with the doctor or follow-up care specialist, you can take notes or record your talks to refer to later. Talk about any concerns you have related to your follow-up care plan.

Your Follow-Up Care Schedule

Each patient has a different follow-up care schedule. How often you return for follow-up visits is based on:

• the type of cancer you had
• the treatment you received
• your overall health, including possible treatment-related problems

In general, people return to the doctor for follow-up appointments every 3 to 4 months during the first 2 to 3 years after treatment, and once or twice a year after that.

At these visits, you may have a physical exam along with blood tests and other necessary tests and procedures. Which tests you receive and how often you receive them will be based on what your doctor thinks is best for you when creating your follow-up care plan.

What to Tell Your Doctor During Follow-Up Visits

When you meet with your doctor for follow-up visits, it’s important to talk openly about any physical or emotional problems you’re having. Always mention any symptoms, pain, or concerns that are new or that won’t go away. But keep in mind that just because you have new symptoms, it doesn’t necessarily mean the cancer has come back. It’s normal to have fears about every ache and pain that arises, but they may just be problems that your doctor can easily address.

Other things you should tell your doctor:

• Any physical problems that interfere with your daily life, such as fatigue; problems with bladder, bowel, or sexual function; having a hard time concentrating; memory changes; trouble sleeping; or weight gain or loss
• Any new medicines, vitamins, herbs, or supplements you’re taking
• Changes in your family medical history
• Any emotional problems you’re having, such as anxiety or depression

It’s important to be aware of any changes in your health between scheduled visits. Report any problems to your doctor immediately. They can decide whether the problems are related to the cancer, the treatment you received, or an unrelated health issue.

Your Treatment Summary

Your oncologist or a member of your treatment team should give you a written summary of the treatment you received. Keep this with you to share with your primary care doctor and any other doctors you see. Many people keep their treatment summary in a binder or folder, along with their medical records. This way, key facts about your treatment will always be in the same place.

Types of health information in the treatment summary

The date you were diagnosed

• The type of cancer you had
• Pathology report(s) that describe the type and stage of cancer in detail
• Places and dates of each treatment, such as the details of all surgeries; the sites and total amounts of radiation therapy; and the names and doses of chemotherapy and all other drugs
• Key lab reports, x-ray reports, CT scans, and MRI reports
• List of signs and symptoms to watch for and possible long-term effects of treatment
• Contact information for all health professionals involved in your treatment
• Any problems that occurred during or after treatment
• Any supportive care you received during treatment (such as medicines for depression or anxiety, emotional support, and nutritional supplements)

Many cancer survivors say that getting involved with their follow-up care was a good way for them to regain some of the control they felt they lost during cancer treatment. Being an active partner with your doctor and asking for help from other members of the health care team is the first step. Knowing what to expect after cancer treatment can help you and your family make plans, lifestyle changes, and important decisions about the future.

Guidelines for a Healthy Lifestyle After Cancer Treatment

After cancer treatment, many survivors want to find ways to reduce the chances of their cancer coming back. Some worry that the way they eat, the stress in their lives, or their exposure to chemicals may put them at risk for recurrence. Cancer survivors find that this is a time when they take a good look at how they take care of themselves and how they might live a healthier life.

Ask your doctor about developing a survivorship care plan that includes ways you can take care of your physical, emotional, social, and spiritual needs. If you find that it's hard to talk about these issues, it may be helpful to know that the more you do it, the easier it becomes. Your doctor may also suggest another member of the health care team for you to talk with about wellness, such as a social worker, nutritionist, clergy member, or nurse.

Some general tips for all cancer survivors include:

Quit smoking. Smoking after cancer treatment can increase the chances of getting cancer at the same or a different site.

Cut down on how much alcohol you drink. Drinking alcohol increases the risk of certain cancers.

Maintain a healthy weight. Eating well and staying active can help you reach a healthy weight and stay there.Eat well. A healthy and balanced diet is important for overall wellness. This includes eating fruits, vegetables, whole grains, and protein. Talk with your doctor or a dietitian to find out about any special dietary needs that you may have. You could also ask if you should talk to a nutritionist for guidance on eating a healthy diet.

Eat well. A healthy and balanced diet is important for overall wellness. This includes eating fruits, vegetables, whole grains, and protein. Talk with your doctor or a dietitian to find out about any special dietary needs that you may have. You could also ask if you should talk to a nutritionist for guidance on eating a healthy diet.

Exercise and stay active. Research suggests that staying active after cancer may help lower the risk of recurrence and lead to longer survival. In addition, moderate exercise (walking, biking, swimming) for about 30 minutes every—or almost every—day can:

• Reduce anxiety and depression
• Improve mood and boost self-esteem
• Reduce fatigue, nausea, pain, and diarrhea

It’s important to start an exercise program slowly and increase activity over time. Some people may need to take special care in exercising. Talk with your doctor before you begin any exercise program, and work with your doctor or a specialist (such as a physical therapist) if needed. If you need to stay in bed during your recovery, even doing small activities can help. Stretching or moving your arms or legs can help you stay flexible, and relieve muscle tension.

A survivorship care plan is a record of your cancer and treatment history, as well as any checkups or follow-up tests you need in the future. It may also list possible long-term effects of your treatments, and ideas for staying healthy.

How Can I Use a Survivorship Care Plan?

A survivorship care plan includes important information about your cancer and treatment, which helps you and your doctors understand each other. Bring it with you whenever you go to the doctor.

Your plan should say when you need to get follow-up tests, and which doctors are responsible for your care. Keep your plan and refer to it so you can be sure you get the tests you need.

How to Get a Survivorship Care Plan

Your doctor may give you a survivorship care plan during your cancer treatment, or when you finish your treatment. If you did not get one, ask your doctor about it.

There is no one “right” way to feel after cancer treatment. Each person’s experience is unique. But here are some common emotions and ways to cope with them.

Stress

Life after cancer can be as stressful as treatment. Family life, work, finances, and staying healthy are a lot to deal with. Some ways to reduce stress are listed below. Try these or other approaches, and find out which work best for you.

• Physical activity reduces stress and eases tension, both physically and mentally. Physical activity releases endorphins (feel-good hormones). It also helps stretch out muscles that can become tight due to stress. Check with your doctor before you start to make sure there aren’t any exercises you should avoid.
• Meditation and guided relaxation can help quiet your mind. Look for classes in your community or download apps and videos that you can use at home.
• Creative activities like art, dance, music, writing, or crafts can help you work out feelings, calm your mind, and give you something enjoyable to focus on.
• Sharing personal stories gives you a chance to talk about how you’re feeling and hear how other cancer survivors are adjusting.

Anxiety and Depression

It’s normal to still feel angry, tense, or sad after treatment. These feelings may go away over time. If these emotions feel overwhelming, you could be experiencing anxiety or depression. Start by talking to your doctor about options. Reach out for help right away.

Loneliness

After treatment, it’s easy to feel cut off from other people who may not understand what you’re going through. You may also miss the support you received from your health care team. But support is out there!

• Ask your nurses and doctors if you can still call them. This can help you stay connected.
• Support groups—in person or online—are a great way to meet with other survivors to share feelings, concerns, and journeys to a “new normal.”

Anger

You may feel angry during and after treatment for a lot of reasons: the diagnosis itself, a bad experience with a doctor, or an unsupportive friend or relative. These feelings may go away over time as you settle into your new routine. The tips below may help.

• Ask yourself: What’s causing my anger and what can I do about it? Answering these questions and talking about how you’re feeling can help you manage your anger.
• Learn ways to calm your temper. You can learn ways to redirect angry feelings and reframe your thoughts.
• Focus on what you can control. Being involved in your health care, keeping your appointments, making changes in your lifestyle, or even setting your daily schedule are things you can control. When you feel more in control, you’re less likely to feel frustrated and angry.
• Take action. Sometimes the best way to cope with anger is to join a cause. For example, becoming a cancer advocate could help give purpose and meaning to your experience.

Coping with Chemo Brain

You may have heard about “chemo brain.” Chemo brain is a term cancer survivors use to describe thinking and memory problems that may happen during and after cancer treatment. Emotional and mental health challenges such as depression, anxiety, stress, and having trouble sleeping can add to that foggy feeling. Chemo brain can also intensify feelings of frustration or anger. That’s OK. These feelings can be managed.

Sexual health and intimacy are important parts of a person’s well-being. They are closely linked to how you see yourself and relate to others. It can be challenging after cancer treatment to face sexual health concerns, even if you’ve been with your partner for years. But talking about your concerns openly and honestly—letting your partner know what you’re going through and understanding how they feel—may help prevent frustration and confusion.

Common Concerns and Challenges

• Worrying about intimacy after treatment.
• Struggling with body image after treatment.
• Fearing that having sex will hurt, that you won’t be able to perform, or that your partner will find you less attractive.
• Not being able to have sex as you did before. Some cancer treatments cause changes in sex organs that can also affect your sex life. This can include not being able to get or keep an erection, pain, or loss of sensation.
• Experiencing menopausal symptoms, such as hot flashes, dryness or tightness in the vagina, or other problems that can affect your desire to have sex.
• Concerns about losing the ability to have children. Depending on the type of treatment, your age, and the length of time since treatment, you may still be able to have children. Talk to your doctor or a specialist if you’re concerned about fertility.

If you need help talking about sexual health, intimacy, or fertility, there are resources to help. The first step is talking with your doctor. He or she can help you with changes you’re going through that may be related to your cancer or its treatment. Your doctor can also refer you to programs or professionals who specialize in sexual intimacy counseling for cancer survivors.

How to Get Help

Whether you have concerns about having (or not having) children, physical problems relating to sexual health and intimacy, medication side effects, or your emotional state, professionals can help you.

• Psychologists, clinical social workers, and counselors can help you talk through and process problems you’re struggling with, like stress or body image issues. Professionals who specialize in infertility counseling can also help you with the emotional considerations of various options for building your family.
• Marital counselors are trained specifically to help people strengthen their marriages and partnerships by addressing challenges. Marriage counselors can help start and guide conversations between you and your partner.
• Faith or spiritual counselors can help you cope with concerns such as feeling alone, searching for meaning, and having doubts about your faith.
• Obstetrician-gynecologists (ob-gyns) are doctors who specialize in the female reproductive system and pregnancy. They can answer questions about fertility, birth control, menopause, and reproductive health. Your ob-gyn may refer you to a fertility specialist.
• Fertility specialists (also called reproductive endocrinologists) can determine your ability to have children and offer options for starting or building a family. They evaluate cancer diagnosis, treatment, and possible late side effects of treatment to determine fertility.
• Urologists are doctors who specialize in treating the urinary tract system and male reproductive organs.
• Social workers are trained to counsel you about treatment issues and interpersonal problems related to cancer. They can connect you with resources and services in your area.
• Sex therapists may be able to help you talk openly about your problems, work through your concerns, and come up with new ways to help you and your partner.

If you can’t find a program in your area, look into alternatives to in-person support, such as virtual support groups and therapy by telephone, video, or text.

When treatment ends, families are often unprepared for the fact that recovery takes time. In general, your recovery will take much longer than your treatment did. Survivors often say that they didn't realize how much time they needed to recover. This can lead to disappointment, worry, and frustration for everyone.

Families also may not realize that the way their family works may have changed permanently as a result of cancer. They may need help dealing with the changes and keeping the "new" family strong.

Some survivors say they would not have been able to cope without the help and love of their family members. And even though treatment has ended, they still receive a lot of support. For other families, problems that were present before the cancer diagnosis may still exist, or new ones may develop. You may receive less support than you had hoped.

Common problems with loved ones:

• People expect you to do what you did before your cancer. For instance, if you used to take care of the house or yard before your treatment, you may find that these jobs are still too much for you to handle. Yet family members who took over for you may want life to go back to normal. They may expect you to do what you used to do around the house.
• You may expect more from your family than you receive. They may disappoint you, which might make you angry or frustrated. For example you may get less attention and concern than you did during treatment.
• You may still need to depend on others during this time. Even though you want to get back to the role you had in your family before, it may take a while to get into a routine.

At the same time you’re going through these things, your family is still adjusting too. It may be hard for all of you to express feelings or know how to talk about your cancer.

Getting Help with Family Issues

After treatment, you may want to consider getting help from someone to help you and your family adjust. Ask your doctor or social worker to refer you to a counselor. An expert on family roles and concerns after cancer treatment may help your family work on your problems.

How do you cope with family issues? Here are some ideas that have helped others deal with family concerns:

• Let others know what you're able to do as you heal - and what not to expect. For example, don't feel like you have to keep the house or yard in perfect order because you always did in the past.
• Know that this is a new time in your life so it may take time to adjust. Roles in the family may change again and different emotions may get triggered. This is normal.

Give yourself time. You and your family will be able to adjust over time to the changes cancer brings. Just being open with each other can help ensure that each person's needs are met. Good communication is still very important.

Talking with Children and Teens

Help the children in your family understand that it may take a while for you to have the energy you used to have now that you are finished with treatment. Be open about what you can and can’t do.

You don't have to tell your kids about every checkup or every symptom that occurs. But do tell them if you still have side effects that make certain things hard for you to do. If you’re not able to do an activity or go to an event, the children may think that you’re unhappy or mad at them.

Children of cancer survivors have said that these things are important once their parent has finished treatment. That you:

• Be honest with them
• Speak as directly and openly as possible
• Keep them informed about your cancer and involved in your recovery
• Spend extra time with them

With your permission, other family members should also be open with your children about your cancer and its treatment.

If you have cancer now or had cancer in the past, you may have a higher risk of getting very sick with COVID-19. Cancer patients and survivors—and the people who take care of them—can take steps to protect their health.

COVID-19 Risk for Cancer Patients and Survivors

COVID-19: Are You at Higher Risk for Severe Illness?COVID-19: Are You at Higher Risk for Severe Illness?Low Resolution Video

This video explains who is at increased risk for serious COVID-19 illness and offers tips to avoid getting sick.

Cancer and some of its treatments, such as chemotherapy, can weaken your immune system and make it harder for your body to fight infections. Having a weakened immune system, also known as being immunocompromised, can make you more likely to get very sick if you get COVID-19.

People who are immunocompromised, or who are taking medicines that weaken their immune system, may not be protected as well as others, even if they are up to date on their vaccines.

What You Can Do

You can take steps to lower your risk of getting very sick with COVID-19.

• Stay up to date with COVID-19 vaccination and booster doses. Use CDC’s booster tool to check when to get your COVID-19 booster and find a vaccine location in your community.
• Wear a well-fitting mask, wash your hands often, and use other preventive measures to protect yourself and others from COVID-19. Check COVID-19 community levels to make an informed decision about how best to protect yourself when indoors in public.
• If you have COVID-19 symptoms, get tested right away. Get treatment soon after you develop symptoms if you test positive for COVID-19.
• Have a plan [PDF-561KB] in place for treatment. Discuss treatment options with your health care provider. Contact your health department or community health center to learn more about treatment.

Visiting Friends and Family with Higher Risk for Severe IllnessVisiting friends and family with higher risk for severe illnessView Transcript Low Resolution Video

When you visit a person who has cancer, take these steps to lower the chance of spreading COVID-19.

Family Members and Caregivers

If you live with or take care of someone who has cancer, take steps to protect yourself and others from COVID-19, so you don’t pass it to the person who has cancer. Stay up to date with COVID-19 vaccines, including boosters. Take extra prevention actions, like wearing a mask and ensuring good ventilation, when you’re indoors with a person who has cancer.

While the completion of your child’s cancer treatment is something to celebrate, it may also bring new challenges. You may worry that the cancer will return. Your child may struggle to get used to new routines. Some families enter this new phase feeling stronger, whereas others are more fragile. Many families are surprised by anxious feelings that arise during this long-awaited time, when they expected to feel only relief. Instead of this being a time to go back to life as it used to be, it may be a time of continued adjustment, as you leave the security of the people on your child’s health care team. Some said the transition to life after treatment took longer and was more challenging than they thought it would be.

Follow-Up Care after Cancer Treatment

Get a written copy of your child's treatment summary and survivorship care plan. Ask for recommendations to hospitals that offer the type of follow-up or survivorship care that your child needs.

Treatment Summary

The treatment summary includes both diagnostic and treatment information, such as:

• Type of cancer, severity (stage, grade, or risk group), date of diagnosis, and pathology report
• Type(s) of treatment received, including the names and doses of all medications, as well as the total amounts and sites of any radiation therapy received
• Treatment dates
• Key reports and scans, such as CT scans and MRIs
• Side effects and/or complications experienced during treatment
• Supportive care received (also called palliative care)—such as counseling or physical therapy
• Identifying number and title of the clinical trial, if your child was in a clinical trial
• Names and contact information of key people on your child’s health care team

Survivorship Care Plan

A survivorship care plan (also called a follow-up care plan) is developed for each child. Survivorship care plans are based on the type of cancer and treatment your child received. For example, some children may need to return for visits each month for the first year after they have completed treatment. Others may not need to return as often. Here is the type of information that’s included in follow-up care plans for children who have been treated for cancer, as outlined in the Institute of Medicine's Cancer Survivorship Care Planning Exit Disclaimerfact sheet:

• Exams and tests/procedures to check for the recurrence or metastasis of cancer, and a schedule of when they are needed
• Care and support to manage any long-term side effects and check for late effects
• Psychosocial support or counseling, and referrals as needed
• Referrals for legal aid or financial support, as needed
• Referrals to, and coordination with, specialists such as cardiologists, education specialist, endocrinologists, physical therapists, and psychologists and to appropriate treatments, clinical studies, and rehabilitation specialists
• Recommendations for healthy behaviors, such as advice regarding nutrition and physical exercise
• Family-based care, education, and outreach to your child and family

Follow-Up Care Clinics/Survivorship Clinics

Places that specialize in follow-up care for children who have been treated for cancer are called follow-up care clinics or survivorship clinics. At these clinics, your child will see specialists (in cardiology, endocrinology, fertility, nutrition, psychology, and/or pulmonology, for example) who will monitor your child’s health. These clinics are usually found within hospitals.

Long-Term and Late Effects

Although many side effects go away once treatment has ended, long-term side effects, such as fatigue, may take some time to go away. Other side effects, called late effects, may not occur until months or even years after treatment.

Whether or not your child may have late effects of treatment depends on the type of cancer your child had and how it was treated, as well as personal factors, such as:

• Cancer-related factors such as the type of cancer, where it was in the body, and how it affected tissues and organs
• Treatment-related factors such as the type and dose of treatment(s) or the type of surgery
• Patient-related factors such as your child’s gender, age at diagnosis, length of time since diagnosis/treatment, personal and family health history, and health habits

Types of Late Effects

Late effects may be physical, emotional, or cognitive. Knowing what symptoms to be aware of and when they may occur can help you plan for the needs of your child. Not knowing what to expect can cause anxiety for some parents. However, for other parents, knowing about late effects that may or may not happen to their child in the future can be overwhelming. Many parents find it helpful to ask their child’s doctor what to focus on at each step of their child’s recovery.

Physical Late Effects

Physical late effects involve changes to organs, tissues, and/or body functions. They may affect your child’s growth and development. Some children who have been treated for cancer have many physical late effects, whereas others have relatively few.

Emotional Late Effects

Emotional late effects include changes to your child’s mood, feelings, and actions. Many children are very resilient after cancer treatment. Others experience social and/or emotional problems. If your child is not sleeping well and no longer enjoys activities that he once did, it is important to talk with your child’s doctor about having your child evaluated for depression.

Some children develop post-traumatic stress disorder (PTSD). This anxiety disorder arises in reaction to physical injury or severe mental or emotional distress. Symptoms of PTSD may include having flashbacks about diagnosis or treatment, avoiding places that are reminders of the experience, and being fearful, irritable, unable to sleep, or having difficulty concentrating. Ask your child’s health care team to suggest resources for mental health support in your area.

Cognitive Late Effects

Cognitive late effects include changes in your child’s ability to memorize, learn, and think. These types of late effects are more likely to occur in children who’ve had certain cancers such as brain and spinal cord tumors, head and neck cancers, and some types of leukemia, such as ALL. Treatments such as radiation therapy to the head and certain types of chemotherapy also increase the risk of cognitive late effects. These late effects are also more likely in children who were very young during treatment, who received very high doses of treatment, and whose treatment lasted for a long time.

Children with cognitive late effects may have a more difficult time:

• Memorizing or remembering
• Learning (handwriting, spelling, reading, vocabulary, and/or math may be particularly challenging)
• Thinking (including concentrating, completing work on time, doing work that involves multiple steps, problem solving, and planning)

Questions to Ask Your Child's Health Care Team

As you talk with your child's doctor, here are some questions to consider:

About treatment

• Who should we talk with to get a comprehensive record of treatment(s) and medications that our child received during treatment?

About practical steps to take at home

• What health problems in our child should we be aware of?
• Who should I contact if health problems occur?
• Does my child need to continue taking any medicine(s)? If so, for how long?
• What types of activities may help my child? Are any activities not recommended?
• What vaccines should my child receive? When should they be given?

About follow-up care (plan and schedule)

• Who should I talk with to get a follow-up care plan and schedule for my child?
• What medical experts should my child see for follow-up care?
• What tests will be done during follow-up care visits? How often and for what reason?
• Where should my child go for follow-up care visits?
• What is the schedule for these visits?

About possible long-term and/or late side effects

• Is my child at increased risk of having long-term side effects? If so, which ones and how can they be managed?
• Is my child at increased risk of developing late effects later in life? If so, which ones? How likely are these to occur? How long after treatment might they occur?
• What types of specialists should my child see to manage these effects?

About support and coping

• What survivor support groups are available for my child? For our family?
• What are the benefits to my child of receiving professional counseling? Is this something you recommend for my child? Why or why not?

When you have finished your cancer treatment, you will talk with your doctor about next steps and follow-up care. You may want to ask your doctor some of the following questions:

• How long will it take for me to get better and feel more like myself?
• What kind of care should I expect after my treatment?
• What long-term health issues can I expect as a result of my cancer and its treatment?
• What is the chance that my cancer will return?
• What symptoms should I tell you about?
• Who do I call if I develop these symptoms?
• What can I do to be as healthy as possible?
• Which doctor(s) should I see for my follow-up care? How often?
• What tests do I need after treatment is over? How often will I have the tests?
• What records do I need to keep about my treatment?
• Is there a counselor I can talk to or an online or in-person support group you can suggest?

Each cancer survivor’s journey is unique. But it’s important for all survivors to take steps to stay healthy, both physically and emotionally.

“This is your new normal, so embrace it for what it is,” says Wenora, who has survived several kinds of cancer. “And continue looking forward to the future, because none of us know what that will bring.”

How to Lower Your Chance of Getting Cancer Again

If you have had cancer, you have a higher chance of getting cancer again than someone who has not had cancer. That’s why it’s very important for you to do things to stay healthy.

Follow-up care. When your treatment is finished, your doctor may tell you that you should get checkups or tests in the future. Be sure to follow your doctor’s instructions. These tests can help find early signs of a new cancer or the same cancer.

Healthy choices. Some of the best things you can do for your health include staying away from tobacco, protecting your skin from too much sun, and keeping a healthy weight.

Keys to Physical Health

“A few months after my final remission, I’d go to the gym and struggle with just the bar, or just struggle with trying to walk on a treadmill for more than 2 minutes,” says Mark, who was diagnosed with Hodgkin lymphoma at age 26. “You have to take those baby steps to get out and make it better.”

Three areas of physical health are important for all cancer survivors and key to your recovery and well-being—

Eating Healthy

After cancer, it may not be easy to eat well, but it’s important. A healthy diet can help you feel better, regain your strength and energy, and reduce your risk of serious health problems.

Staying Active

Cancer survivors who keep a healthy weight and stay physically active may have a lower risk of having cancer come back. Start small and try to build up to 30 minutes of movement a day.

Sleeping Well

Many cancer survivors have trouble sleeping. Healthy sleep habits can help.

Keys to Emotional Health

After treatment, cancer survivors need time to recover, improve their mental health, and process their emotions. It’s normal to feel relief, gratitude, and excitement, and at the same time feel worried or sad.

“At 34, I had to have a radical hysterectomy to treat my uterine cancer,” says Xenia. “I’ve never felt more alone or lost in my life But, through counseling with my psychiatrist and just reaching out to different young adult organizations, I was able to create a new normal.”

Understanding Common Feelings

There is no one “right” way to feel after cancer treatment. It’s normal to still feel angry, tense, or sad. These feelings can be managed.

Coping With Your Feelings

You may feel uncomfortable talking about your struggles. Every feeling you have is real and valid. It’s OK to reach out for help.

Talking to Your Loved Ones

Talking to your family and friends may be challenging. It’s important to share how you’re feeling and accept help.