Follow up care for Hodgkin’s Lymphoma Patients

Summary

Follow-up refers to when even after a person is treated for cancer, the medical team will continue to diagnose Hodgkin’s Lymphoma cancer, manage side effects and treatment delays, and monitor the patients’ overall health. The patients may need to repeat tests such as a CT scan and a PET-CT scan during the follow-up care. Follow-up care looks for cancer recurrence, managing long term side effects, and keeping records of personal health.

Introduction

Care for patients diagnosed with lymphoma does not end with active treatment. There will be follow-up care where the medical team will continue to diagnose cancer, manage side effects and treatment delays, and monitor the patients’ overall health.

Follow-up treatment may include regular physical exams, medical exams, or both. The doctor will want to track the recovery of the patients for months or years to come. Frequency of additional treatment types of tests necessary depends on several factors. It can be the initial size and type of treatment for Hodgkin’s lymphoma. Tests like CT scans and PET-CT scans at the end of the treatment can ensure that the body is cancer-free. However, studies have shown that routine follow-up, also called “observational imaging”, is usually not necessary and can be necessary if there are signs or symptoms of recurrence of lymphoma. The doctor should say if the patient needs to repeat tests such as a CT scan and PET-CT scan and how often the patient should have a physical exam.

People with Hodgkin’s lymphoma should get the flu vaccine every year. Some survivors may require getting a pneumonia vaccine every 5 to 7 years.

Cancer rehabilitation can mean a wide range of services such as physical therapy, occupational counselling, pain relief, diet planning and/or emotional counselling. Rehabilitation helps people regain control of many aspects of life and remain as independent and productive as possible^​1​.

Watching for recurrence

One of the goals of follow-up treatment is to identify recurrence, which means cancer has come back or not. Cancer recurrence occurs because of the small cancer cells which are undetectable in the body. The number of these cells may increase over time until they appear in the test results or cause signs or symptoms. During the further treatment of the cancer patient, the doctor, with knowledge of the patient’s medical history, can provide them with personalized information about the risk of recurrence. The doctor will also ask the patient-specific questions about the health during the follow-up.

In most cancer centers, follow-up is done every 3 to 4 months for the first 1 to 2 years after treatment ends, when there is the highest risk of recurrence. After that, the time between visits increases with time. Subsequent visits are possible only 2-3 times a year until the 5th year has passed. After 4-5 years, the doctor discusses long-term monitoring with the patient in the medical team. This may include going to a cancer center’s designated survivor clinic, continuing treatment with a cancer treatment team, or going into a long-term plan with a primary care provider^​1​.

Managing long-term and late side effects

Most people expect side effects during treatment. However, to the surprise of many survivors, some side effects may persist after the end of the treatment period. These are called long-term side effects. Other side effects, called late stages, can occur months or years later, which may include both physical and emotional changes. The patient should consult with the doctor about the risk of these side effects based on the type of cancer, the individual treatment plan, and general health. If the patients had treatment that is causing some delayed effects, they might need some physical exams, scans, or blood tests to help find and manage it. Lifelong cancer screening and detection and cardiovascular risk factors should be given special attention. Monitoring thyroid function is important for people receiving radiation therapy to the neck or chest.

Follow-up treatment should also address quality of life, including emotional issues. In particular, survivors of Hodgkin’s lymphoma are encouraged to be aware of the symptoms of depression and to consult a doctor immediately if such symptoms are present.

Keeping personal health records

The patient and the doctor should work together to develop a personalized follow-up plan. The doctor should discuss any concerns about future physical or emotional care.

Follow-up care is a good time to talk to the doctor about who will guide the patient’s future care. Some survivors continue to see an oncologist, while others see their primary care doctor or other health care professional. This decision of multiple visits for follow-up care depends on several factors, including the type and stage of cancer, side effects, health insurance policy, and personal preferences.

Suppose a doctor who is not directly involved in the cancer treatment will administer the follow-up care. In that case, the patient should share the cancer treatment summary and survival plan form with that doctor and discuss all future follow-up cares. The details of the cancer treatment are very important to the health care professional who will care for the patients for the rest of their life^​1,2​.

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