Nursing Considerations for Lymphoma Survivorship Care
As treatments have advanced and patients and providers have more options, cure and survivorship rates for lymphomas are improving (https://www.cancer.org/cancer/hodgkin-lymphoma/about/key-statistics.html): five-year survival rates for Hodgkin and non-Hodgkin lymphoma are 86% and 71%, respectively. Despite good results from treatment, research indicates that lymphoma survivors carry a significant amount of late and chronic effects. Even in a complete remission, late effects of treatment present (https://doi.org/10.1200/CCI.18.00015) a burden for patients' physical and psychosocial well-being.
Late and Long-Term Effects
Lymphoma survivors are at risk for various late and long-term effects largely dependent on the treatment modality, specific agents prescribed, and dosage received. For radiation, effects vary based on location and intensity but commonly involve skin effects, fatigue, cardiac arrythmias, and pneumonitis. Late effects (https://ascopost.com/issues/november-10-2017/life-after-treatment-managing-lymphoma-survivors) occurring months or years after treatment include (https://www.cancer.org/cancer/hodgkin-lymphoma/after-treatment/lifestyle-changes.html) pulmonary toxicities, radiation fibrosis, cardiomyopathy, coronary artery disease, hypothyroidism, and secondary malignancies (https://www.uptodate.com/contents/approach-to-the-adult-survivor-of-classic-hodgkin-lymphoma) such as myelodysplastic syndrome, leukemia, or breast cancer.
Chemotherapy side effects are also related to specific agents but generally include fatigue, peripheral neuropathy, fertility, sexual side effects, menopausal symptoms, pulmonary toxicity (pneumonitis), and cognitive dysfunction. If patients received combination therapy (https://www.cancer.org/cancer/hodgkin-lymphoma/after-treatment/lifestyle-changes.html) with anthracyclines, secondary malignancies and cardiovascular effects are also considerations (Olsen et al., 2019), or bone changes and immunosuppression may result from combination treatments with steroids (Ofshenko, 2019).
Cellular treatments such as stem cell transplantation and CAR T-cell therapy are associated with extensive long-term and late effects. Key considerations include (https://www.cancer.org/cancer/hodgkin-lymphoma/after-treatment/lifestyle-changes.html) immunosuppression, infection, graft-versus-host disease, organ toxicities, infertility, and secondary malignancies (https://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf) such as post-transplant lymphoproliferative disorder.
Ongoing Screening and Prevention
Cardiovascular disease and secondary malignancies are the most common causes (https://www.uptodate.com/contents/approach-to-the-adult-survivor-of-classic-hodgkin-lymphoma) of morbidity and mortality in lymphoma survivors, so screening for and preventing future malignancies is a critical component of survivorship care. Recommendations should be tailored to specific patient factors, risks factors, comorbidities, and family history, but in general, lymphoma survivors should have routine blood work, including lipid panels, and monitoring for secondary malignancies. Health maintenance plans should encourage routine, age-appropriate cancer screening, regular exercise, smoking cessation, limited alcohol consumption, sun safety, and appropriate vaccinations. Dietary recommendations include (https://www.uptodate.com/contents/the-roles-of-diet-physical-activity-and-body-weight-in-cancer-survivors) high consumption of fruits, vegetables, and whole grains (https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf) and reduced amounts of fat, processed foods, and red meat.