Follow-Up Care for Non-Hodgkin Lymphoma
by Katherine L. Byar, MSN, APN, BC, and Julie M. Vose, MD
Improvements in therapy have increased survival rates for many people with non-Hodgkin lymphoma. However, NHL survivors are still at risk for developing late complications after treatment ends. Routine follow-ups are needed to assess any long-term side effects of therapy and to check for signs of cancer recurrence. Most relapses occur within the first three years after finishing treatment. You should have follow-up visits with your oncologist/hematologist every two to four months for the first couple of years following treatment, followed by checkups every three to six months for the next three to five years. After five years, you can switch to annual exams.
Follow-up exams should include a review of your medical history, a physical examination, and a complete blood cell count and chemistry panel, including a lactate dehydrogenase (LDH) test. Intermittent scans should also be conducted as indicated. In addition to these follow-up visits with your oncologist/hematologist, routine checkups for other healthcare maintenance are necessary.
As a non-Hodgkin lymphoma survivor, you should incorporate healthy practices into your lifestyle to decrease your risk of developing complications.
While you were undergoing treatment for NHL, other aspects of your health may have been overlooked or interrupted temporarily. Therefore, it is vital to re-establish care with your primary care provider. You should schedule a periodic health exam with your primary care provider at least once every year to screen for healthcare problems that commonly develop with age, as well as to identify modifiable risk factors for the development of future health problems. This exam should include blood pressure screening and pulse, height, and weight measurements.
For women, a clinical breast exam-ination should be performed annually. Women should also perform monthly breast self-exams. If you have received chest radiation, you should be screened annually with mammography or breast MRI beginning at age 40, or five to eight years following the radiation therapy. Pap and pelvic examinations should be performed every one to three years, depending on your risk factors for cervical cancer. Sexually active women should be screened for STDs in accordance with their risk.
Dr. Julie Vose
For male survivors, prostate cancer screening is recommended beginning at age 50, or earlier if risk factors for prostate cancer are present.
Laboratory testing is also an important part of long-term follow-up for NHL. In addition to laboratory tests that your oncologist/hematologist may recommend, your glucose and lipid levels should be checked periodically. This is especially important for cancer survivors who are obese, who have high blood pressure, or who have a family history of heart disease, stroke, or diabetes. If you were treated with radiation in the neck or upper chest region, your thyroid-stimulating hormone levels should be checked at least yearly.
Other tests that should be part of regular follow-up care for lymphoma survivors include a bone density (DEXA) scan and colonoscopy. DEXA scans screen for osteoporosis or abnormally thin bones, which can increase your risk of fractures. DEXA scans should be performed every two years for postmenopausal women and for people who have received chemotherapy. Colon- oscopy is a screening test for colon cancer. It is recommended at age 50, or earlier if an immediate family member has been diagnosed with colon cancer.
If you have an increased risk for cataracts or other eye diseases, you should have annual eye examinations. Some of the risk factors for disease of the eye include a history of corticosteroid use, radiation to the head, diabetes, hypertension, and sun exposure.
Keeping immunizations up to date is another important part of follow- up care. You should talk with your physician about recommendations for immunizations. If you have undergone a transplant, these recommendations may differ from those for people who have only received chemotherapy. Recommended immunizations may include an annual flu shot; a tetanus booster every ten years; a pneumococcal vaccine one year after completing treatment and a booster in five years; a meningococcal vaccine for those without a functioning spleen or for those who are living in a dormitory setting; and an HPV vaccine for women under 26 years old. Zoster (shingles) vaccines should be avoided in people with a history of lymphoma.
As a non-Hodgkin lymphoma survivor, you should also incorporate healthy practices into your lifestyle to decrease your risk of developing complications. These include maintaining a healthy diet, quitting smoking, using sunscreen, and getting regular exercise. In addition, you should report any changes to your body, whether mental or physical, to your doctor.
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Katherine Byar is a hematological malignancy nurse practitioner in the section of Hematology/Oncology, and Dr. Julie Vose is a Neumann M. and Mildred E. Harris professor and chief of the section of Hematology/Oncology, both at the University of Nebraska Medical Center in Omaha, NE.
This article was originally published in Coping® with Cancer magazine, September/October 2013.