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Non-Hodgkin lymphoma

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Supportive care for non-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 cancer. 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 non-Hodgkin lymphoma (NHL) 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 NHL may have the following concerns.

Infection

Aggressive combination chemotherapy to treat NHL can cause bone marrow suppression, which results in low white blood counts (neutropenia) and an increased risk of infection. Bacterial infections are the most common infection following chemotherapy for NHL. Other treatments, such as radiation therapy, corticosteroids, and splenectomy, can suppress the immune system and increase the risk of infection. Although the risk of infection is usually short-lived and occurs while the person is actively receiving treatment, the risk of infection after certain treatments can become a long-term problem.

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Treatment-induced menopause

Menopause is caused by reduced levels of hormones, mainly estrogenestrogenA female sex hormone that causes the female sex characteristics to develop (such as breasts) and is necessary for reproduction. and progesteroneprogesteroneA female sex hormone that prepares the uterus (womb) for pregnancy and the breasts for lactation following childbirth. produced by the ovaries. It occurs naturally as women age, usually when a woman reaches her early 50s. Some women may have premature menopause (treatment-induced menopause) because of some of the chemotherapy drugs used to treat NHL or if the ovaries receive radiation when radiation therapy is given to the pelvis during treatment. Women who are closer to natural menopause (over 35) are at the greatest risk of treatment-induced menopause, which is often permanent.

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Fertility problems

Infertility is the inability to conceive a child. Fertility problems can affect both men and women following treatment for NHL. Whether infertility occurs as a result of treatment for NHL depends on the type of treatment and the area of the body that was treated. Combinations of chemotherapy drugs used to treat aggressive NHL may cause infertility. There is a higher risk of infertility with combinations that include drugs called alkylating agents, like cyclophosphamide (Cytoxan, Procytox). Radiation therapy to the pelvis and surrounding areas may also cause fertility problems. Infertility is also an important side effect that can occur in people who have a stem cell transplant because of the high doses of chemotherapy given for transplantation.

Women treated for NHL who are closer to their natural menopause (over 35) are at the greatest risk of becoming infertile because the treatment may cause premature menopause. Although younger women being treated for NHL may experience menopausal symptoms (during which they are temporarily infertile), they have a better chance of their periods returning and becoming fertile again.

Men may have temporary or permanent infertility because of decreased or stopped sperm production, depending on the treatment they receive.

People concerned about their fertility should talk to their doctor before their treatment is started.

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Heart problems

Radiation to the chest and certain chemotherapy drugs, like doxorubicin (Adriamycin), can potentially damage the heart. Heart (cardiac) problems that may occur include:

  • inflammation of the protective sac that surrounds the heart (pericarditis)
  • narrowing or blocking of the blood vessels of the heart (coronary artery disease or CAD)
  • scarring or weakening of the heart muscle (cardiomyopathy)
  • increased fluid buildup in the sac surrounding the heart (pericardial effusion)

Shortness of breath and swelling (edema) of the hands or feet can occur because of congestive heart failure (weakening of the heart muscle) and irregular heartbeats.

Chemotherapy drugs can cause heart problems during and for a long time after treatment. Heart problems are not very common with radiation therapy to the chest, but occasionally occur as a late effect. Radiation therapy to the chest can also cause congestive heart failure and coronary artery disease, which puts a person at risk for heart attack. Steps are taken to detect, prevent and treat these heart problems.

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Thyroid problems

People who receive radiation therapy for NHL to the neck area are at an increased risk for developing hypothyroidism (a decrease in thyroid function) later in life. Hypothyroidism usually develops 3–4 years after radiation therapy treatment, but can also occur several years later. Thyroid function needs to be checked regularly and medications (thyroid hormone replacement) may be needed to regulate the thyroid gland.

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Lung problems

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

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

Radiation pneumonitis and pulmonary fibrosis can cause cough or shortness of breath.

Radiation pneumonitis usually develops 1–3 months after radiation treatment begins for NHL, but can occur several months after treatment is completed. Pulmonary fibrosis can occur months or years after radiation therapy.

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Second cancers

Although uncommon, a different (second) cancer may develop after treatment for NHL. Whether or not a second cancer develops depends on:

  • the type of chemotherapy drugs given
  • the dose of chemotherapy drugs given
  • the length of treatment for NHL
  • if radiation therapy was also given
    • The combination of chemotherapy and radiation therapy increases the risk of second cancers.

There is also a small risk that young women who have had radiation therapy to the chest to treat their NHL can later develop breast cancer. People who receive a stem cell transplant to treat their NHL 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.

Although the possibility of developing a second cancer is frightening, the benefit of treating NHL 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, 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.

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

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