Learn more about the basics of bone marrow transplants. Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs.
Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem.
Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
However, progressive disease is uncommon for people with Hodgkin lymphoma. If progression happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. Complete recovery from progressive Hodgkin lymphoma is not always possible.
This treatment appears to be more effective for progressive Hodgkin lymphoma than standard chemotherapy. Palliative care is also important to help relieve symptoms and side effects. For most people, a diagnosis of progressive Hodgkin lymphoma is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.
A remission is when lymphoma cannot be detected in the body and there are no symptoms. A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the disease returning.
Understanding your risk of recurrence and the treatment options may help you feel more prepared if the lymphoma does return. Learn more about coping with the fear of recurrence. If the lymphoma returns following remission after the original treatment, it is called recurrent lymphoma. Recurrence is uncommon for people with Hodgkin lymphoma. However, if Hodgkin lymphoma does recur, a new cycle of testing much like that done at the time of diagnosis will begin again to learn as much as possible about the recurrence.
After this testing is done, you and your doctor will talk about the treatment options. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent lymphoma. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent lymphoma often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope.
Recovery from Hodgkin lymphoma is not always possible. If the lymphoma cannot be cured or controlled, the disease may be called advanced or terminal. This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns.
The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.
Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important. It is also important to discuss newer treatment options that are being tested in clinical trials. Finding a second opinion may be useful, too. People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations.
Nursing care and special equipment can make staying at home a workable option for many families. Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment.
Is that okay? Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets. So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy. Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment.
This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied books and music. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment. Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have. We don't yet know much scientifically about how some nutritional or herbal supplements might interact with chemotherapy.
Some could be harmful. It is very important to tell your doctors if you take any supplements, or if you are prescribed them by alternative or complementary therapy practitioners. Talk to your specialist about any other tablets or medicines you take while you are having active treatment.
Some studies seem to suggest that fish oil preparations might make some chemotherapy drugs work less well. If you take or are thinking of taking these supplements, talk to your doctor to find out whether they could affect your treatment.
Chemotherapy for non-Hodgkin lymphoma can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home. All chemotherapy drugs used to treat non-Hodgkin lymphoma NHL have side effects. The drugs affect people in different ways. Most side effects are temporary but some can be permanent.
Your treatment depends on the type, grade and stage of your non-Hodgkin lymphoma. Treatment might include chemotherapy, targeted drugs, steroids, radiotherapy and transplants. Combinations of different drugs are named after the initials of the drugs used.
These are the most common chemotherapy and chemoimmunotherapy treatments for NHL:. The chemotherapy drugs are given into a vein. You also take steroid tablets called prednisolone.
This treatment is called:. This is a combination of the chemotherapy drugs cyclophosphamide and vincristine which are given into a vein. This is when the chemotherapy drug gemcitabine is added to CVP. If the lymphoma does not completely respond to chemotherapy, your doctor may advise different or stronger drugs than you had before. If this happens the lymphoma can still be treated successfully.
Sometimes your doctor may talk to you about having intensive chemotherapy and a stem cell transplant. With some types of NHL, there is a higher risk of lymphoma cells spreading to the brain. This can happen with some types of high-grade NHL or when lymphoma is in certain areas of the body. You may have a type of chemotherapy to treat or prevent lymphoma in the brain. This is called intrathecal chemotherapy. A doctor puts a small amount of liquid chemotherapy into the spinal fluid.
This is done in a similar way to a lumbar puncture. You usually have intrathecal chemotherapy as an outpatient. The chemotherapy drug most commonly used is methotrexate. Another way to treat or prevent lymphoma in the brain is to give high doses of methotrexate into a vein. In this situation, you may not need intrathecal chemotherapy. Your doctor or nurse will explain how much chemotherapy you will have and how long your treatment will take. This will depend on the stage and type of Hodgkin lymphoma you have.
Sometimes your doctor may advise changes to your chemotherapy drugs. A nurse or pharmacist in the day chemotherapy unit will give directions on how to safely take medications at home. Patients will be given extremely specific information on the dose, side effects, health monitoring and information on how to safely handle and manage chemotherapy at home. Oral chemotherapy does not come without side effects, so it is important that patients let their medical team know if there are any concerns or a dose is missed.
Examples of oral chemotherapy are chlorambucil or cyclophosphamide. Intravenous chemotherapy is given into a vein.
Intravenous chemotherapy can either be given through a cannula , or a central venous access device CVAD. A cannula is a small soft plastic tube that is inserted into a vein in your hand or arm. The cannula is usually inserted by a doctor or nurse. Prior to inserting the cannula, the area is cleaned and prepared.
The needle is then put into the skin. The needle is removed, and a small soft plastic tube is left in place. It is securely taped in place for the duration of the treatment. The cannula is usually taken out on the day after the treatment is completed. A central venous access device is a thin plastic tube that remains in your vein throughout the course of treatment. It is not removed after each cycle. Examples of central venous access devices are:.
This plastic tube is a lot bigger than the plastic tube in a cannula, and it is put into a bigger vein. Central venous access devices are put in under local or general anaesthetic. These devices can be left in for months or for the duration of the whole treatment.
Patients will be given strict directions about how to care for their device and will also be given strict instructions on the signs and symptoms of infection in the device.
Once the cannula is inserted or the central venous access device is accessed, premedications and chemotherapy are then administered by the nurses in the day oncology unit. Premedications can be given as a push or through a pump. Chemotherapy drugs are usually mixed in the pharmacy and delivered to the oncology day unit. They are then administered as bolus or through an intravenous pump. All medications are administered differently.
Some medications may take a few minutes to administer while others may take a few hours. The health care team will be able to explain all of this to you prior to the treatment. Examples of intravenous chemotherapy are doxorubicin , cyclophosphamide , and vincristine. Intrathecal chemotherapy is given into the fluid that surrounds the brain and spinal cord. This is called the cerebrospinal fluid CSF. The brain and spinal cord are surrounded by a highly selective semipermeable border of endothelial cells called the blood-brain barrier.
The blood-brain barrier prevents solutes in the circulating blood from crossing into the extracellular fluid of the central nervous system where the neurons reside. The blood-brain barrier prevents many drugs from getting into the central nervous system. Intrathecal chemotherapy is the way of bypassing the blood-brain barrier. The drug is given directly into the central nervous system.
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