2020-08-21
Long-Term Effects of Cancer Treatment in Survivors
癌症治疗的长期副作用
Updated January 22, 2018
As cancer survival rates improve, late effects of cancer treatment are becoming increasingly important. These symptoms, at least one of which is present in more than half of cancer survivors, have received less attention until recently, as our focus has been on the treatment, and hopefully cure, of the disease. These conditions may persist and/or arise months, years, and even decades after treatment, and can significantly lower the quality of life for people who have survived cancer.
随着癌症生存率改善，癌症治疗的长期副作用变得越来越重要。过半数癌症幸存者出现至少一种长期副作用。最近，这些副作用才获得关注，这是因为焦点一直在治疗上，希望能治愈癌症。副作用在治疗后的数月、数年、乃至数十年出现，并/或长期存在，会明显地降低癌症幸存者的生活质量。
Since the 1970s there has been a 3-fold increase in the number of cancer survivors living in the United States, with an estimated 13,500,000 survivors in the United States in 2012, and 30 million survivors worldwide. In the United States, 3 percent of the adult population has survived cancer for 5 years or more.
自20世纪70年代起，在美国，癌症幸存者的人数增加3倍，预计2012年美国有13500000名幸存者，全球范围内则多达3千万人。在美国，3%的癌症成年患者治疗后生存5年或以上。
If you are wondering if you fit the definition of a cancer survivor, a survivor is defined as anyone who has been diagnosed with cancer beginning on the day of diagnosis and continuing through the remainder of their life. What are some of these symptoms and conditions, and what help is available?
癌症患者自确诊的一刻起成为幸存者，直至生命的最后一刻。所以，癌症幸存者面对什么症状和疾病，又能获得什么帮助？
Heart disease is a leading cause of illness and death among cancer survivors. This article focuses on adults treated for cancer, but it's important to note that people treated for cancer as children or adolescents are 8 times more likely to experience heart disease than people of the same age who have not been treated for cancer. Several treatments for cancer can predispose to heart disease, and often people with cancer receive a few of these treatments combined. Some of the most common causes include:
心脏病是癌症幸存者主要的疾病成因及死因。本文聚焦于癌症成年患者，但值得注意的是，癌症儿童或青少年患者发生心脏病的概率是同龄健康人的8倍。有些癌症治疗会令人容易患上心脏病，癌症患者通常会接受其中一些治疗，包括：
Chemotherapy drugs, especially drugs such as Adriamycin (doxorubicin).
化疗药，尤其是亚德里亚霉素等药物。
Radiation to the chest—for example with lung cancer, left-sided breast cancer, and lymphomas.
胸部放疗，例如肺癌、左侧乳腺癌和淋巴瘤。
Targeted therapies such as antibodies used in breast cancer like Herceptin.
靶向药，例如乳腺癌的抗体药（例如赫塞汀）。
Cancer treatments can affect the heart in different ways and result in different conditions. Some of these include:
癌症治疗会影响心脏，从而导致不同的疾病，包括：
Cardiomyopathy - Cardiomyopathy (weakness of the heart muscle) leading to heart failure is the most common cardiac side effect of cancer treatment. Chemotherapy medications, especially drugs such as Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide) are not uncommonly associated with heart failure. If you were treated with medications in these categories, your oncologist may have ordered an echocardiogram to evaluate your cardiac ejection fraction prior to beginning chemotherapy.
心肌病：导致心力衰竭的心肌病是癌症治疗最常见的心脏副作用。化疗药，尤其是亚德里亚霉素和环磷酰胺等药物，与心力衰竭的关联性是常见的。医生会为接受这些药物治疗的患者开具超声波心动图检查，以评估化疗前心脏排血指数。
Radiation to the chest, for example for Hodgkin's disease, left-sided breast cancer, or lung cancer, is another important cause of heart disease. A study published in 2007 suggested that 10 to 30 percent of people treated with chest radiation are likely to experience heart disease within the next decade. This study needs to be interpreted with caution, however, as newer radiation techniques (heart sparing techniques) that reduce radiation to the heart have been developed since that time.
胸部放疗，例如霍奇金病、左侧乳腺癌或肺癌，也是心脏病重要的成因。一项2007年研究显示，10%-30%的胸部放疗患者很可能在接下来的10年内发生心脏病。由于后来研发出能减少心脏的辐射暴露的新型放疗，该研究需谨慎解释结果。
That said, heart failure can often begin with only vague symptoms such as fatigue, a decrease in endurance, swelling in the legs, or shortness of breath with activity. If you have received these medications or have had radiation therapy to your chest, ask your oncologist if she would recommend a cardiac consult. Some cancer centers now have cardio-oncology programs to address these concerns, especially if you have a personal or family history of heart disease, or other heart disease risk factors such as diabetes. And, even if you think your symptoms are nothing, it is always better to be safe than sorry when it comes to your heart.
心力衰竭一开始通常只有轻微症状，例如疲乏、忍耐力减弱、腿部肿胀或锻炼时气促。服用这些药物或做过胸部放疗的患者可询问肿瘤科医生是否建议到心脏科咨询。有些癌症中心目前开设肿瘤心脏病学项目，解决关切，有个人心脏病史或心脏病家族史，或其他心脏病风险因素（例如糖尿病）的癌症患者尤其需要注意。即使症状轻微，也切勿掉以轻心，毕竟心脏事大，确保安全总好过以后遗憾。
Coronary artery disease - Some cancer treatments can damage the lining of heart vessels leading to premature heart disease. As noted above, this is especially true in children, adolescent, and young adult cancer survivors.
冠状动脉疾病：有些癌症治疗会损害心血管内膜，从而导致过早发生的心脏病。如上文所述，癌症儿童、青少年和年轻成年幸存者尤其会发生。
Arrhythmias - Cancer treatments may also damage the "electrical system" of the heart resulting in abnormal heart rhythms (arrhythmias). If you experience lightheadedness, palpitations, or feel like your heart is beating slow or instead racing, make sure to let your doctor know.
心律失常：癌症治疗也会损害心脏电传导系统，从而导致心律失常。如果经历头晕、心悸、或感到心脏跳得慢或过快，请确保告知医生。
While not as serious as heart disease, cancer fatigue is an all-too-common symptom affecting the majority of cancer survivors. In addition to the quality of life issues, fatigue may be a risk factor for lower survival. Cancer fatigue is difficult to understand if you haven't experienced it yourself; it's not the kind of tiredness that can be relieved with a good night of rest or a cup of coffee. Tension with loved ones may develop as your friends and family expect you to return to your pre-cancer self after treatment. If you are finding this frustrating, you aren't alone. Check out these tips for coping with cancer-related fatigue, and, better yet, print the article and hand it to family and friends who "just don't get it."
虽然不及心脏病严重，癌症相关性疲乏是大多数癌症幸存者再常见不过的症状。除了生活质量问题，疲乏也是生存期缩短的风险因素。癌症相关性疲乏只有经历过才会懂，这不是睡一晚好觉，喝杯咖啡就能消除的疲劳。亲友对患者恢复到患癌前状态的期望会造成关系紧张。为此灰心的癌症幸存者绝不止一个。请了解癌症相关性疲乏的应对提示，并将这种疲乏的科普性文章打印出来给亲友传阅。
But first, have a good conversation with your doctor. There are some causes of fatigue caused by cancer treatments that may be treatable. One example is long-standing anemia following chemotherapy. Another example is hormonal changes. Radiation therapy to the head and neck can result in low thyroid hormone levels (hypothyroidism) which can cause or contribute to fatigue in addition to causing other symptoms. In contrast to hypothyroidism, chemotherapy may also result in hyperthyroidism (an overactive thyroid) which may cause weight loss, a tremor, and anxiety that can be severe.
首先，患者应与医生进行良好交谈。有些癌症治疗引起的疲乏成因可以治疗。其中一个范例就是化疗后长期贫血。还有激素变化。头颈部放疗可能会导致甲状腺功能减退，从而可能导致或促进疲乏，并导致其他症状。化疗则可能会导致甲状腺机能亢进，从而可能导致体重减轻、震颤和或会恶化的焦虑。
There are many other causes of fatigue following cancer treatment, some that are treatable, others that are not, but your doctor will only know to examine you and order necessary tests if you speak up. If you have an overwhelming desire to cover your head with your pillow when your alarm announces morning, talk to your doctor.
癌症治疗后疲乏还有很多其他成因，有些可治疗，有些不可以，但医生只有在患者开口后才会开具检查处方。如果早上起不了床，请与医生谈谈。
Insomnia is common among cancer survivors and often persists for years beyond treatment. While this symptom may sound trivial to some, chronic insomnia not only reduces the quality of life but raises the risk of further physical and psychological problems. Research has found that cognitive behavioral therapy for insomnia (CBTI) can significantly improve this symptom for many people with cancer.
失眠在癌症幸存者中很常见，通常会在治疗后持续多年。虽然这种症状听起来象是小事，慢性失眠症不仅会降低生活质量，还会增加进一步的身心疾病风险。研究显示失眠症的认知行为疗法可明显地改善很多癌症患者的症状。
Peripheral neuropathy—damage to nerves leading to the arms and legs that are often permanent—is a very frustrating late effect of cancer treatment. This condition affects roughly a third of people with cancer, and its incidence is increasing. Symptoms may include numbness, tingling, "pins and needles" pains, and cold intolerance typically found in a "stocking-and-glove" distribution. Decreased sensation in the hands and feet can interfere with simple activities such as buttoning clothes, or difficulty placing your feet, resulting in falls. Many chemotherapy medications can cause neuropathy, but most commonly occurs with drugs such as Platinol (cisplatin) and Taxol (paclitaxel). Treatment often involves the use of medications such as topical gels, antiepileptic drugs, antidepressant medications, and sometimes narcotic medications for severe pain. Alternative therapies, such as massage, acupuncture, and guided imagery may offer significant relief for some people. Research is ongoing looking at ways to prevent neuropathy from occurring during chemotherapy.
外周神经病变：手臂和腿部的神经损伤往往是长期的，是癌症治疗令人沮丧的长期副作用。这种疾病影响约1/3的癌症患者，其发病率还呈上升趋势。症状包括麻木、刺痛、针刺感和寒冷耐受不良（手脚冰凉）。手脚感觉减弱会干扰简单活动，例如扣纽扣、或难以摆放脚部，从而导致摔倒。很多化疗药会导致神经病变，但最常见的是顺铂和紫杉醇。外周神经病变治疗通常是药物治疗，包括外用凝胶、镇痫剂、抗抑郁药，有时会用麻醉剂治疗严重疼痛。按摩、针刺疗法和引导想象等替代疗法对一些患者有很大的缓解作用。为了预防化疗期间发生的神经病变，研究在持续进行当中。
Popularly coined "chemobrain," cognitive challenges following chemotherapy have received attention in recent years. Symptoms such as difficulty multi-tasking and difficulty concentrating may begin during chemotherapy and persist for months or years. Radiation therapy to the head and neck regions for head and neck cancers, brain tumors, brain metastases and prophylactic cranial irradiation (PCI) (used for some people with lung cancer) can also contribute to these symptoms. For some people, trying to focus on one task at a time, keeping lists to compensate for memory gaps, and doing "brain exercises" such as sudoku may be helpful. For others, consulting with a neurologist or psychologist may be recommended when symptoms are interfering with daily life.
俗称化疗脑的化疗后认知问题近年受到关注。难以一心多用和集中精神等症状或会在化疗期间出现，并持续数月或数年。头颈癌、脑癌、脑转移灶的头颈部放疗和预防性全脑照射（PCI）也可能会导致这些症状。一次只进行一个任务，保持记录清单的习惯，及进行数独等脑锻炼会有帮助。当症状干扰到日常生活，建议咨询神经科医师或心理医生。
Post-traumatic stress disorder in cancer patients is another condition which has recently received more attention among cancer survivors. This condition, which is better known as occurring among those who have been exposed to war, or rape victims, for example, is thought to be present in as many as 35 percent of patients following treatment. The treatment for PTSD can involve several modalities, but the most important step is in recognizing this oft underdiagnosed condition in the first place.
癌症患者的创伤后应激障碍也在近期受到更多癌症幸存者的关注。公众多半将这种疾病和曾参与战争的士兵或性侵受害者拉上关系，但其实有人认为，多达35%的癌症患者在治疗后有这个问题。创伤后应激障碍有几种治疗方法，但最重要的一步是将这种诊断不足的疾病识别出来。
While depression is no more common among cancer survivors than those who have not experienced cancer, anxiety is a significant problem. One study looking at almost 50,000 cancer survivors found that 18 percent of these people suffered from anxiety after treatment was completed. This anxiety did not appear to decrease with time, and, in fact, those who were 10 or more years out from treatment had an especially high rate of anxiety. A fear of cancer recurrence is one form of anxiety that is a concern that most, if not all cancer survivors experience from time to time.
无论有没有患癌，都会发生抑郁症，但焦虑是显著的问题。有项针对近50000名癌症幸存者的研究显示，18%的患者在治疗后出现焦虑。这种焦虑似乎不会随时间减退，事实上，治疗结束10年或以上的癌症幸存者的焦虑率特别高。癌症复发恐惧是一种焦虑，经常令大多数癌症幸存者担忧。
If you are finding that anxiety is a concern for you, talk with your doctor. This symptom does not necessarily mean you need a prescription medication, and in contrast, alternative therapies such as acupuncture, massage, breathing exercises, and guided imagery, may help you cope with this symptom while benefiting you overall as well.
如果认为自身有焦虑问题，请与医生谈谈。这种症状不一定意味着需要处方药，针刺疗法、按摩、呼吸锻炼和引导想象等替代疗法有助于应对，同时带来总体获益。
Concerns about fertility may pale in comparison to the diagnosis of cancer but are a very real concern for young adults with cancer. These articles discuss how cancer treatments may affect fertility for both men and women.
对比起癌症，不孕不育似乎不那么令人担忧，但对癌症年轻成年患者来说，这是确实存在的担忧。
Many chemotherapy and hormonal treatments can lead to bone loss. This, in turn, can lead to fractures. It's important to talk to your doctor about measuring your bone density if this has not been done, as well as checking your vitamin D level, as a vitamin D deficiency can lead to osteoporosis as well as other conditions. In addition, some research suggests that for some cancers the risk of recurrence may be lower for people who have adequate vitamin D.
很多化疗药和激素疗法会导致骨质流失，从而导致骨折。重点是与医生谈论骨密度检查，同时监测维生素D水平，因为维生素D不足可能会导致骨质疏松症及其他疾病。另外，有些研究显示，维生素D充足者的癌症复发风险可能会更低。
Sexual dysfunction is a very common, and equally frustrating problem among people who have survived cancer. Cancer can cause physical and hormonal changes which limit sexual enjoyment, and of course, the emotional upheaval which plays upon these physical changes. This article on nurturing your sexuality during cancer treatment discusses some of the causes, as well as tips for enhancing your sexuality post-treatment that you may not have crossed your mind.
性功能障碍在癌症幸存者中很常见，这也是令人沮丧的问题。癌症可能会导致身体和激素变化，从而限制性愉悦，带来情绪波动。
Many cancer treatments are designed to damage the DNA of cells in order to cause the death of cancer cells. Unfortunately, normal cells are often affected in the process, which can result in the development of cancer years and decades later. Chemotherapy, especially drugs such the alkylating agents, for example, Cytoxan (cyclophosphamide,), topoisomerase inhibitors (for example, Etoposide), and anthracycline agents (for example, Adriamycin (doxorubicin) pose the highest risk of secondary cancers. Radiation therapy may also predispose to secondary malignancies in the future. It's important to keep in mind that the risk of these cancers usually pales in comparison to the benefits of these treatments in treating primary cancer.
很多癌症治疗旨在损害细胞DNA以杀死肿瘤细胞。不幸的是，健康细胞也会受波及，从而导致多年乃至数十年后发生癌症。化疗，尤其是烷化剂等药物，例如环磷酰胺、拓扑异构酶抑制剂（例如依托泊苷）和蒽环霉素（例如亚德里亚霉素）有最高的继发性癌症风险。放疗也可能会令人容易患上继发性恶性肿瘤。记得这些癌症风险通常低于原发癌治疗获益。
Cancer treatments can affect nearly any region or organ system in the body. Lymphedema, kidney damage, pulmonary fibrosis, tooth decay, hearing loss, and cataracts, to name only a few concerns, are more common among those who have survived cancer than among the general population.
癌症治疗可能会影响几乎任何部位或器官。与一般大众相比，淋巴水肿、肾损伤、肺纤维化、蛀牙、听力损耗和白内障在癌症幸存者中更常见。
It's very important that oncologists and primary care physicians work together to form a smooth transition for cancer survivors. Many oncologists work with their patients to complete a "survivorship care plan" which reviews follow-up information, symptoms to watch for, and other information for survivors going forward. If you don't have a survivorship care plan, ask your oncologist to work with you to complete one. Here is an example of a template of a care plan developed by the Minnesota Care Alliance, It can't be stressed enough how important it is to have copies of your medical records on hand to carry with you.
肿瘤科医生和初级保健医师共同合作，顺利交接很重要。很多肿瘤科医生会与患者合作，制定癌症幸存者护理方案，内容包括随诊信息、需注意的症状和其他对幸存者生活有帮助的信息。没有这种方案的幸存者可要求肿瘤科医生与其共同制定一份。还有，患者随身携带病历复印件很重要。
Since the concept of "cancer survivorship" is relatively new, many cancer survivors still find themselves falling between the cracks after treatment. More than once I've heard the remark that someone was dismissed by their oncologist, leaving them with the feeling that they should just be thankful that they survived. But as noted above, the majority of people who have survived cancer have some lasting effects. It's important that any issues you have are addressed, but the only way that medical professionals will know of your concern is if you speak up.
由于癌症幸存者观念相对较新，很多癌症幸存者仍感到自己治疗后被忽视。有些患者觉得肿瘤科医生给他们一种感觉，他们还活着就已经万幸了。如上文所述，大多数癌症幸存者有些长期副作用。重点是有问题就解决，但只有患者开口，医生才会知道。
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