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Supportive care for Hodgkin lymphoma
Supportive careSupportive careTreatment given to improve the quality of life of people who have a serious illness (such as cancer). helps people meet the physical, practical, emotional and spiritual challenges of Hodgkin lymphoma (HL). 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 HL and adjusting to life after treatment is different for each person, depending on the extent 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. A person who has been treated for HL may have the following concerns.
How a person feels about or sees themselves is called self-esteem. Body image is a person’s perception of their own body. HL 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:
For many people, body image and their perception of how others see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may be afraid to go out or afraid others will reject them. They may feel angry or upset. Body changes can be troubling because of the importance of the particular change in the body to the person.
For unknown reasons, the immune system of people with HL does not work properly and treatments such as radiation therapy and chemotherapy can add to this problem. Because of this, infections can be a problem for people with HL, both during and after treatment. It is important to prevent infections, treat them early if they occur and to keep up with immunizations.
When radiation therapy is given to the pelvis to treat HL, it may affect fertility. The reproductive organs may be affected by radiation therapy, depending on the dose of radiation given. Women may experience premature menopause or infertility if the ovaries receive radiation. Men may have reduced or absent sperm production during therapy if the testicles receive radiation. Depending on the dose received, this may result in infertility.
When possible, measures are taken to protect the reproductive organs from radiation as long as the HL can still be adequately treated. This can help the person maintain their fertility.
Radiation to the neck area to treat HL can cause hypothyroidism (a decrease in thyroid function). The thyroid gland makes hormones that help regulate and maintain many body functions. Symptoms of hypothyroidism include fatigue, hair loss, brittle nails, dry skin and changes in menstruation in women.
Hypothyroidism usually develops 3–4 years after treatment, but it can also occur several years later.
Thyroid function is checked and daily medications (thyroid hormone replacement) may be needed to regulate the thyroid gland.
Problems with thyroid function are often permanent.
High doses of radiation therapy to the chest and chemotherapy given to treat HL can cause lung and heart problems. Lung problems can occur when the trachea (windpipe) and bronchi become irritated if they are in the treatment area. Lung problems sometimes start during radiation treatment, but they usually occur a few months or more after treatment is completed.
Heart problems are not very common with radiation therapy to the chest, but they can occur as a late problem. Heart problems may occur if the treatment area includes the heart and mediastinummediastinumThe space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes., and especially if the person also received certain chemotherapy drugs.
Heart and lung problems can be managed, but they are often long-standing problems.
There is an increased risk for dental cavities after treatment for HL if radiation therapy is given to the head or neck area. Radiation may affect the salivary glands and the production of saliva. This depends on the dose of radiation and the number of salivary glands irradiated. Less saliva in the mouth can lead to an increase in dental cavities (caries) and gum disease. Tooth pain, tooth decay and swollen, painful gums can result.
Measures should be taken to prevent or decrease the severity of dental cavities, including:
- a complete dental checkup, cleaning and filling of cavities before treatment begins
- good daily oral hygiene and fluoride treatments during and after treatment
- regular visits to the dentist after treatment, for checkups, cleaning and treatment of any problems
The person needs to continue to take good care of their teeth and gums to help prevent tooth decay.
Although uncommon, a different (second) cancer may develop after treatment for HL. Whether or not a second cancer develops depends on the type and dose of chemotherapy drugs given and if radiation therapy was also given. The combination of chemotherapy and radiation therapy increases the risk of second cancers.
There is a small risk that young women who have had radiation therapy to the chest to treat HL will later develop breast cancer. People who receive a stem cell transplant to treat HL are at a higher risk of developing an acute leukemia or myelodysplastic syndromemyelodysplastic syndromeA group of disorders that affect the bone marrow so it does not produce enough healthy mature blood cells. People with MDS have low white blood cell counts, low platelet counts and increased monocytes in some cases. Signs and symptoms include fever, easy bruising and bleeding, infections, paleness a. Other second cancers usually develop in irradiated areas such as the thyroid, lung, gastrointestinalgastrointestinalReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine. tract, skin and cervix.
Although the possibility of developing a second cancer is frightening, the benefit of treating HL with chemotherapy or radiation therapy usually far outweighs the risk of developing another cancer.
Living a healthy lifestyle and working with your healthcare professional to develop a wellness plan for staying healthy may help lower the risk of second cancers. Routine screening to detect second cancers early and being aware of changes in your health and reporting problems to the doctor are also important parts of follow-up care after cancer treatment.