Care and mobility considerations
Low grade Non-Hodgkin Lymphoma
The commonest type of low grade lymphoma is Follicular lymphoma and the care and mobility needs refer to this type of lymphoma. Other low grade lymphomas have varying outcomes. These different types and their features are listed and should be referred to when reviewing care and mobility needs.
First line treatments early disease
There are unlikely to be disabling effects of disease. Treatment usually consists of a short course of radiotherapy over 4 weeks. A return to health for a prolonged period is expected in the typical case. Long term survival of 10 years without relapsed disease is good at 80%. Those with relapsed disease will go on to have further treatment.
First line treatment for advanced disease (stage II, III, IV) or Relapsed disease (second line, third line treatment etc.)
The commonest treatment likely to be given is combination chemotherapy. This is an arduous treatment and needs related to side effects may be identified. Time limited awards of one year are recommended.
Mobility
Severe fatigue and reduced exercise tolerance related to any of the following may reduce the ability to walk-:
- Chemotherapy treatment e.g. peripheral neuropathy affecting the feet
- Anaemia
- Disease effects e.g. lung involvement causing breathlessness
People who are immunosuppressed may be advised to avoid crowded public places.
Care
Severe fatigue may make activities of daily living difficult. Help with activities of daily living from someone else may be required because of pain, fatigue or dizziness.
High grade Non-Hodgkin Lymphoma
The commonest type of high grade lymphoma is Diffuse large cell lymphoma and the care and mobility needs refer to this type of lymphoma. Other high grade lymphomas have varying outcomes. These different types and their features are listed and should be referred to when reviewing the Care and Mobility needs.
High grade Non-Hodgkin Lymphoma First line treatment for advanced disease (stage II, III, IV) or Relapsed disease (second line, third line treatment etc)
First line treatment and recovery for those who successfully undergo combination chemotherapy is likely to take 6 months to a year.
People with relapsed disease will have salvage chemotherapy. If they respond to this they will go on to have high dose chemotherapy and Peripheral Blood Stem Cell Transplant (PBSCT) or bone marrow transplant. Non responders will usually live less than 6 months.
For those who undergo bone marrow or stem cell transplant the treatment and recovery period is likely to take 12 months occasionally upto18 months.
During recovery from transplant they are likely to have periods of being immunosuppressed and be advised to avoid crowded or enclosed public places e.g. public transport at busy times and people who are unwell. Episodes of severe fatigue may endure for many months related to chemotherapy treatment and anaemia.
Some will be unwell and have care or mobility needs for about 3 months - during the transplant and transplant recovery period. Some will be unwell for much longer.
The main cause of ongoing needs in both groups is likely to be severe chemotherapy related fatigue.
If high dose chemotherapy and transplant has already been used then other types of chemotherapy may be given to control disease and symptoms, in this case ongoing needs may relate to symptoms of disease as well as treatment.
Mobility
Severe fatigue and reduced exercise tolerance related to any of the following may reduce the ability to walk:
- Chemotherapy treatment e.g. peripheral neuropathy affecting the feet
- Anaemia
- Disease effects e.g. lung involvement causing breathlessness
People who are immunosuppressed may be advised to avoid crowded public places.
Care
Severe fatigue may make activities of daily living difficult. Help with activities of daily living from someone else may be required because of pain, fatigue or breathlessness.
- Low grade table
- High grade table
- Psychological effects
- Problems in adults who had cancer treatment as children
Amended February 2009
