Supportive Care for Lymphoma

Supportive care in cancer is the prevention and management of symptoms and side effects of cancer and its treatment across the cancer continuum from diagnosis to end of life. It includes support for patients, their families, and their caregivers.1

Patient Education and Family Support

Concomitant palliative care with active therapy has been demonstrated to improve patient reported outcomes. It is different from Hospice care. Patients with advanced disease who are expected to live 6 months or less may be appropriate for transition to Hospice care.2 Palliative care involves detailed communication with patients and families and skilled assessment of sources of patient suffering.2

Considerations for Nursing Assessment

Both supportive and palliative care focus on1,2:

  • Reducing symptoms
  • Improving quality of life (QoL)
  • Supporting patients and their families throughout the treatment continuum
    • Supportive care works best when started early in the treatment process in conjunction with active treatment2

Case Coordination

Patient Education and Family Support

Because lymphoma is a heterogeneous disease, it is vital for patients to know their NHL subtype.1

It is also important to provide patients and families with education and reinforcement on the following topics to decrease anxiety3:

  • Diagnosis – Why tests are performed and expectations for specific tests3
  • Treatment options and goals, which vary by subtype3
  • Clinical trial awareness4
  • Recognition and management of side effects, disease progression, and patient adherence3
    • Symptoms that should alert the healthcare team
      • Fever, uncontrolled nausea/vomiting; bruising/bleeding, excessive diarrhea or constipation
      • During watchful waiting: B symptoms (fever, night sweats, weight loss), swollen nodal areas
  • Duration of therapy and follow-up3
  • Patient resources and advocacy groups – Financial and supportive community resources3
  • Survivorship planning3
  • Caregiver support
    • Assist the caregiver by recognizing and addressing some of the causes of caregiver stress and burnout3,5:
Potential causes of caregiver stress and burnout5
Fear and uncertainty Cancer treatment isn’t certain. It’s hard not to worry about 1) the person with cancer, and 2) the future.
Loneliness and isolation Caregiving takes time. Caregivers may find they don’t have time to spend with friends, take part in outside activities, or pursue hobbies.
Shifting roles Caregiving can change relationships. Change can be stressful in relationships, and it can be upsetting when someone who has been a source of strength is suddenly vulnerable, or when caregivers find themselves making decisions somebody else used to make.
Too much to do Caregivers may feel overwhelmed by all they have to do, feeling as though everything is falling on their shoulders.
Little time alone Everyone needs time for themselves. This can be difficult to get when caregivers are looking after someone with cancer.
Constant demands Being on call around the clock can be especially hard.
Financial pressure The costs of cancer care can be a source of stress. Also, the caregiver and the patient may be unable to work full-time or at all.
Guilt Caregivers may feel bad that they can’t give more, or they may feel that they are short-changing other family members and friends.

Considerations for Nursing Assessment

  • Assess patient goals of care3
  • Conduct complete assessment at baseline and subsequent visits3:
    • Consistent use of assessment tools to identify changes over time, treatment related symptoms or potential disease progression, and patient comorbidities4
  • Manage symptoms and side effects4
  • Gauge treatment adherence4
  • Provide psychosocial support4
  • Assess caregiver needs3

Case Coordination

Multidisciplinary team huddles are a good way to keep the lines of communication open so that all providers are on the same page regarding the patient’s treatment needs and goals, which should include3:

  • Evaluating patient’s needs and matching unmet needs with appropriate services and referrals4
  • Expediting care to avoid delays4
  • Coordinating post-treatment care with primary care physician (PCP)3

During treatment, NHL patients become accustomed to working closely with a multidisciplinary team that often includes medical oncologists, radiation oncologists, mid-level practitioners, nurses, and others.6

Ideally, involvement of the patient’s PCP continues during treatment, as the PCP often has a longstanding relationship with the patient that predates the patient’s lymphoma diagnosis.3

  • Maintaining this relationship becomes particularly important after the patient completes treatment

References: 1. Multinational Association of Supportive Care in Cancer. MASCC.ORG. https://www.mascc.org/home/What is Supportive Care? Accessed April 9, 2019. 2. Dans M, Smith TS, Back A, et al. NCCN Guidelines® Insights. Palliative Care, Version 2.2017. Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2017;15(8):989–997. 3. Rummel P. Non-Hodgkin lymphoma and Hodgkin lymphoma: the role of the nurse navigator in improving patient outcomes. http://theoncologynurse.com/categories?view=article&secid=15168:best-practices-in-patient-navigation-first-issue-lymphoma-edition&artid=16419:non-hodgkin-lymphoma-and-hodgkin-lymphoma-the-role-of-the-nurse-navigator-in-improving-patient-outcomes. Updated May 27, 2015. Accessed January 5, 2019. 4. Oncology Nursing Society. Oncology nurse navigator core competencies. www.ons.org/sites/ default/files/ONNCompetencies_rev.pdf. Accessed January 5, 2019. 5. Help for Cancer Caregivers. Caregiver Burnout and Stress. https://www.helpforcancercaregivers.org/content/caregiver-burnout#what-causes-caregiver-stress. Accessed January 5, 2019. 6. Cancer.net. Lymphoma – Non Hodgkin: Treatment Options. https://www.cancer.net/cancer-types/lymphoma-non-hodgkin/treatment-options. Accessed August 26, 2019.