Navigation at the End of Therapy: A Crucial Transition in Lymphoma Treatment
As lymphoma survival rates increase, oncology staff must be cognizant of increasingly complex survivorship issues that may arise.
For a person surviving cancer, the transition from active treatment to survivorship can be an emotional time, confusing, and fraught with challenges. Some patients feel insecure; some patients are able to move forward through the continuum of care, whereas others may not be aware that follow-up visits will continue. People who have survived lymphoma are no different from those who survived other types of cancer. They need the hands-on approach of an oncology nurse to help them navigate through their transition.
Two oncology nurse specialists in Ireland, Fidelma Hackett, a clinical nurse specialist in haematology-oncology at University Hospital Limerick, and Dr. Maura Dowling, senior lecturer at the School of Nursing and Midwifery, National University of Ireland, Galway, conducted a study of lymphoma survivors and their experiences as they ended active treatment and began follow-up care at a large urban hematology center.1
A Lymphoma Snapshot
Lymphoma comprises Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). The diseases are the 17th and 5th, respectively, most commonly occurring cancers in Ireland.1In 2015, 2110 new cases of HL and 13,682 new cases of NHL were reported in the United Kingdom.1In the United States, the American Cancer Society estimates approximately 74,680 new cases of NHL and approximately 8500 new cases of HL will be diagnosed in adults and children in 2018.3
Survival rates for lymphomas are also steadily improving. In the United Kingdom, 63% of patients with NHL and 80% of those with HL survive for 10 years.1In the United States, 10-year survival rates are 80% for HL and 59% for NHL.2-3
Issues Facing Survivors
With more people surviving, as well as receiving, a diagnosis of lymphoma, oncology staff must be cognizant of increasingly complex survivorship issues that may arise, explained Ms Hackett and Dr Dowling. In this study, they explored the challenges patients with HL or NHL may have to cope with as survivors. All study participants were 18 years or older, underwent intensive treatment for lymphoma, able to give consent, and fluent in spoken English so no interpreter would be necessary. In addition, they completed treatment 3 to 60 months prior to the beginning of the project. The investigators conducted semistructured, recorded interviews lasting 18 to 60 minutes.
The investigators found that the participants' most significant issues fit into 5 main themes: dealing with uncertainty, changed relationships, occupational engagement, extended recovery time, and concerns for the future.