Danger legacy of cancer cures

Powerful cancer drugs can cause long-term side-effects

Testicular cancer treatments are now so successful that patients are in more danger from their long-term side effects than from the cancer returning.

The major concern of patients whose cancer is in remission tends to be the re-emergence of their original cancer.

However, the radical surgery, and powerful chemotherapy and radiotherapy used to treat them can also have lasting effects - a trade-off readily accepted by many patients faced with life-threatening illness.

In a way, patients have become the victims of the success of treatment

Dr Karim Fizazi, Institut Gustave Roussy

In the case of some of the most treatable cancers - such as testicular cancer - there is now evidence that there is more chance of becoming ill because of the treatment than of the original cancer coming back.

Testicular cancer has cure rates of over 90% in many cases, and even patients with advanced cancer have a reasonable chance.

However, an editorial in the journal the Annals of Oncology warns that doctors should now be looking to reduce the chances that drugs and treatments could harm health later on.

Researchers at the West German Cancer Center at the University of Essen looked at 32 testicular cancer patients aged between 30 and 59 who had all been successfully treated wtih chemotherapy.

While none had developed different cancers later on - a known risk of chemotherapy - there were alarming cardiovascular side effects of the overall treatment.

Nearly a third had abnormal functioning in part of their heart, although only one, a smoker, had actually suffered a heart attack.

Four out of five had elevated cholesterol levels - 25% had developed high blood pressure after chemotherapy.

In addition, nearly a quarter had hearing loss, and over a third had some problems with nerve damage.

Other Norwegian research, published in the same journal, suggested that chemotherapy and radiotherapy could be causing subtle long-term kidney damage, not enough to produce symptoms by itself, but enough to weaken the organs and perhaps make them vulnerable later in life.

Heart problems

Dr Dirk Strumberg, who led the German research, said it was likely that hormonal and metabolic changes following the treatment - such as lowered testosterone levels - rendered these patients more vulnerable to heart disease.

He said: "Testicular cancer patients should be made aware that they might have a greater risk of developing cardiovascular disease that of suffering a recurrence of their cancer or a second malignancy.

"They can then take measures to minimise this risk, such as controlling their weight, regulating their blood pressure and cholesterol levels and not smoking."

Dr Karim Fizazi, of the Institut Gustave Roussy in France, said that research should now turn to ways of limiting the long-term damage caused by treatment.

He said: "In a way, patients have become the victims of the success of treatment.

"Long-term side-effects of treatment need to be considered since patients who reach the stage of complete response are likely to live for decades."