Late and Long-Term Effects of Treatment for Osteosarcoma

More young people with osteosarcoma are now surviving this cancer. But the treatment may affect their health later in life, so watching for health effects as they get older has become more of a concern in recent years.

Just as the treatment of cancer in young people requires a very specialized approach, so does their care and follow-up after treatment. The earlier any problems are recognized, the more likely it is they can be treated effectively.

Young people with cancer are at risk, to some degree, for several possible late effects of their cancer treatment. This risk depends on a number of factors, such as the type of cancer, the specific cancer treatments they received, doses of cancer treatment, and age when receiving treatment.

For example, as described in the Surgery for Osteosarcoma section, the after-effects of surgery can range from small scars to the loss of a limb, which would require both physical rehabilitation and emotional adjustment.

Other late effects of cancer treatment can include:

  • Heart or lung problems (due to certain chemo drugs or radiation therapy to the chest)
  • Loss of hearing (due to certain chemo drugs)
  • Slowed or decreased growth and development (in the bones or overall)
  • Changes in sexual development and ability to have children (see below)
  • Learning problems in younger children
  • Development of second cancers (see below)

There may be other possible complications from treatment as well. Your child’s doctor should carefully review any possible problems with you before your child starts treatment.

Along with physical side effects, some childhood cancer survivors may have emotional or psychological issues. They also may have problems with normal functioning and school work. These can often be addressed with support and encouragement. Doctors and other members of the health care team can also often recommend special support programs and services to help children after cancer treatment.

Fertility issues

Fertility problems are not common after osteosarcoma treatment, but they can occur. Older girls and women may have changes in menstrual periods during chemotherapy, but normal monthly cycles usually return after treatment ends. Boys and men may lose the ability to make sperm. This usually returns, but the sperm count may remain low. Radiation to the pelvis can also damage reproductive organs, which could affect fertility.

Talk to your (or your child’s) cancer care team about the risks of infertility before treatment, and ask if there are options for preserving fertility, such as sperm banking. For more information, see our documents Fertility and Women With Cancer or Fertility and Men With Cancer.

Development of a second cancer

Rarely, some types of chemotherapy can cause a second type of cancer (such as leukemia), years after the osteosarcoma is cured. Radiation therapy can also raise the risk of a new cancer at the site of the treatment. But the importance of treating the osteosarcoma generally far outweighs this small risk. For more information on second cancers, see our document Second Cancers in Adults.

Long-term follow-up care for children and teens

To help increase awareness of late effects and improve follow-up care of childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what types of screening tests should be done to look for problems, and how late effects are treated.

It’s very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free at the COG website: The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as “Health Links”) on the site as well, but we urge you to discuss them with a doctor.

For more about some of the possible long-term effects of treatment, see the document Children Diagnosed With Cancer: Late Effects of Cancer Treatment.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: April 18, 2014 Last Revised: January 27, 2016

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