Lymphoma survivorship journey

Dr Garrick Laudin describes the lymphoma survivorship journey. 

A recap on lymphoma

Lymphomas are cancers of lymph nodes. The lymphatic system is the main component of the immune system comprised of lymph nodes (site where immune cells reside) and lymphatic channels that closely follow the course of blood vessels. 

Lymphomas encompass two broad groups, namely Hodgkin (HL) and non-Hodgkin lymphoma (NHL). Within the category of NHL, the subtypes are diverse with both aggressive and less aggressive (indolent) forms. The diversity of the lymphoma subtypes also reflects the varied needs and survivorship of patients with these different lymphomas. 

What is survivorship? 

Survivorship refers to the journey of living with and importantly living beyond a cancer diagnosis and treatment thereof. The survivorship journey begins at diagnosis and continues throughout life, with recognition of the impact of a diagnosis on physical, mental, emotional, social, and financial aspects of a patient’s life.

The term survivor isn’t intended simply as a label, but a word to unite a community of individuals who have experienced the hardship of a lymphoma diagnosis and are either currently receiving treatment, in remission, or living cancer-free.  

The journey of survivorship isn’t a solo journey; it requires the continued support from family, friends, caregivers, colleagues, and specialist doctors.   

Active follow-up in the survivorship journey 

There are many reasons why patients, even those who are cancer -free, will require active monitoring throughout their life. With the advent of new therapies in lymphoma and access to personalised medicine, patients will live longer than expected in the past and are therefore exposed to the same risks (as the general population) posed by diseases of lifestyle (hypertension, diabetes, and dyslipidaemia).  

Patients diagnosed with lymphoma also require continued monitoring for disease relapse (lymphoma that comes back again) or the development of new cancers (second cancer). Second cancers are sometimes cited as the leading cause of death in long-term survivors of HL and include: NHL and solid organ tumours (breast, lung, or colon cancer). 

The use of certain treatment modalities, like radiation therapy, may also have major late effects on various organs (lungs, thyroid) depending on the radiation dose and site of the radiation therapy. The functioning of these organ systems is sometimes monitored over time with laboratory (blood tests) and imaging (scan) studies. 

Cardiovascular (heart) disease is also a concern as it’s the most common non-cancer related cause of death in long-term survivors of both HL and NHL. Blood pressure, lipid (cholesterol) and glucose (sugar) monitoring coupled with exercise and good nutrition are essential elements to maintain overall heart health. 

Focus areas during the survivorship journey

Survivors should be able to openly discuss their preferences and concerns with their healthcare providers to individualise their survivorship care. Through proactive planning, lymphoma survivors can navigate their recovery journey with confidence and can focus on wellness and quality of life. Survivorship clinics, where available, may also aid in promoting effective co-ordinated care plans for patients living with lymphoma. 

Regular engagement in physical activity is therefore vital for continued health and emotional well-being in lymphoma survivors. From UpToDate online, studies have shown that NHL survivors who partook in 150 minutes (or more) of moderately vigorous exercise per week had better health-related quality of life compared to those with a more sedentary lifestyle.  

A balanced diet, smoking cessation, and limited alcohol consumption are other ways in which patients may promote good health. Survivors whose immune system has been weakened with cancer treatment may also benefit from infection control measures, such as appropriate hand hygiene, avoidance of large crowds, and staying up to date with adult vaccinations particularly the annual influenza (flu) vaccine. 

Surviving to thriving

The lymphoma survivorship journey is multi-faceted and involves recovery from intense treatment, continued monitoring for lymphoma recurrence, and adapting to a new normal. By integrating a personalised medical follow-up plan and psychosocial support, lymphoma survivors should be empowered to thrive beyond their diagnosis.