Supportive care for non-Hodgkin lymphoma

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of non-Hodgkin lymphoma (NHL). It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from NHL and getting used to life after treatment is different for each person. Recovery depends on the stage and grade of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects.

People treated for NHL may have concerns about the following.

How a person feels about or sees themselves is called self-esteem. Body image is a person’s perception of their own body. NHL and its treatments can affect a person’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

• hair loss
• skin changes
• changes in body weight

Some of these changes can be temporary, others will last for a long time and some will be permanent.

Find out more about self-esteem and body image and managing symptoms and side effects.

Fatigue is a symptom of having a low red blood cell count (called anemia). Red blood cell counts can be low when the bone marrow is affected by NHL or its treatments. Fatigue can also be a symptom of other problems that people with NHL may have, including poor nutrition, sleep problems, anxiety or depression.

Once the cause of fatigue is known, your healthcare team can suggest ways to treat it. Treatments may include:

• iron pills if your iron is low
• blood transfusion for anemia
• nutritional supplements
• sleep medicines
• antidepressants

Find out more about fatigue and anemia.

Infection can develop if you have a low white blood cell count (called neutropenia). White blood cell counts can be low when NHL or its treatments affect the bone marrow.

Preventing infection is important for people with NHL. Having good hygiene, protecting your skin and maintaining good general health are some ways to help prevent infection. It is also important to keep your immunizations up to date to help prevent some infections.

Your healthcare team may give you medicines to prevent infection if you have a low white blood cell count. They will also give you medicines to treat infections, such as antibiotics, antivirals and antifungals.

Find out more about infection, low white blood cell count and immunizations.

Some treatments for NHL can cause fertility problems for both men and women. These problems can include infertility, which is the inability to conceive a child. Whether or not infertility occurs depends on the type of treatment and the area of the body treated. Combinations of chemotherapy drugs and radiation therapy to the pelvis and surrounding areas may cause fertility problems.

Women treated for NHL who are closer to their natural menopause have the highest risk of becoming infertile because the treatment may cause early menopause. Younger women treated for NHL may have menopausal symptoms and become temporarily infertile. They have a better chance of becoming fertile again than older women.

Some treatments can cause temporary or permanent infertility in men if they lower or stop sperm production in the testicles.

Talk to your healthcare team about your fertility before you start treatment. Find out more about fertility problems and treatment-induced menopause.

Radiation to the chest and certain chemotherapy drugs can damage the heart. Heart problems that may develop include:

• inflammation of the protective sac around the heart (called pericarditis)
• narrow or blocked blood vessels of the heart (called coronary artery disease, or CAD)
• scarred or weakened heart muscle (called cardiomyopathy)
• a buildup of fluid in the sac around the heart (called pericardial effusion)

If the heart muscle is weakened (called congestive heart failure) or the heart has an irregular beat, it can cause shortness of breath and swelling of the hands or feet.

Your healthcare team will take steps to prevent, find and treat these heart problems. Find out more about heart damage and chemotherapy.

People who receive radiation therapy for NHL to the neck area have a higher risk of developing hypothyroidism later in life. Hypothyroidism is when the thyroid doesn’t make enough thyroid hormone to keep the body working properly. It usually develops 3–4 years after radiation therapy, but it can also develop later.

The healthcare team will regularly check how well the thyroid is working. Some people need to take thyroid hormone replacement to regulate the thyroid.

Radiation therapy to the chest can damage the lungs. Lung problems that may occur include:

• inflammation of the lungs (called pneumonitis)
• scarring or stiffening of the lung tissue (called pulmonary fibrosis)

Radiation pneumonitis usually develops 1–3 months after radiation therapy begins, but it can also develop several months after treatment is completed. Pulmonary fibrosis can develop months or years after radiation therapy. These problems can cause coughing or shortness of breath.

Find out more about radiation pneumonitis.

In rare cases, a different type of cancer may develop after treatment for NHL. For example, breast cancer can develop in young women who have had radiation therapy to the chest. Lung cancer can develop in people who smoke and have radiation to the chest. Acute leukemia or myelodysplastic syndrome can develop in people who have a stem cell transplant.

The possibility of developing a second cancer is scary, but the benefit of treating NHL with chemotherapy or radiation therapy usually far outweighs the risk of developing another cancer. Whether or not another cancer develops depends on:

• the type of chemotherapy drugs given
• the dose of chemotherapy drugs given
• the length of treatment
• if both chemotherapy and radiation therapy were given

Routine follow-up to find a second cancer early, as well as being aware of changes in your health and reporting problems to your doctor, are important parts of follow-up care after cancer treatment.

During treatment, the focus is getting through treatment and it may be difficult to stay positive. Finances, work, and relationships may be a concern and can cause anxiety. When treatment is finished, you may have other thoughts and unexpected feelings, including:

• concern that the NHL will come back
• worry about the effects NHL will have on your family, friends and career
• questions about your self-worth and identity
• worry about changes in your appearance
• concern about adapting to lifestyle changes
• anxiety because you have less contact with the healthcare team

Talk to your healthcare team about your concerns. They can support you and help you cope with NHL in different ways, including helping you:

• do appropriate physical activities
• maintain good nutrition
• find a good balance between being active and getting enough rest
• communicate openly and honestly about your fears and concerns
• find the right support and treatment for emotional distress, such as counselling or medicines

Learn more about life after cancer treatment and how to cope with your feelings and concerns.

See a list of questions to ask your doctor about supportive care after treatment.