Supporting Cancer Survivors Following Treatment for Non-Hodgkin's and Hodgkin's Lymphoma: A Pilot Study Assessing the Feasibility and Process Outcomes of a Nurse-Led Intervention.

OBJECTIVE: Lymphoma is the sixth most common cancer in Australia and comprises 2.8% of worldwide cancer diagnoses. Research targeting development and evaluation of post-treatment care for debilitating complications resulting from the disease and its treatment is limited. This study aimed to assess the feasibility and acceptability of a nurse-led survivorship intervention, post-treatment in Hodgkin's and non-Hodgkin's lymphoma survivors. METHODS: A single-center, prospective, 3-arm, pilot, randomized controlled, parallel-group trial was used. People with lymphoma were recruited and randomized to the intervention (ENGAGE), education booklet only, or usual care arm. Participants receiving ENGAGE received an educational booklet and were offered 3 consultations (via various modes) with a cancer nurse to develop a survivorship care plan and healthcare goals. Participant distress and intervention acceptability was measured at baseline and 12-wk. Acceptability was measured via a satisfaction survey using a 11-point scale. Feasibility was measured using participation, retention rates, and process outcomes. Data were analyzed using descriptive statistics. RESULTS: Thirty-four participants with HL and NHL were recruited to the study (11 = intervention, 11 = information only, 12 = usual care). Twenty-seven participants (79%) completed all time points from baseline to 12 wk. Seven (88%) of the 8 participants receiving ENGAGE completed all consultations using various modes to communicate with the nurse (videoconference 14/23, 61%; phone 5/23, 22%; face-to-face 4/23, 17%). Participants who completed the intervention were highly satisfied with ENGAGE. CONCLUSION: The ENGAGE intervention is feasible and highly acceptable for lymphoma survivors. These findings will inform a larger trial assessing effectiveness and cost effectiveness of ENGAGE.

Being diagnosed with cancer: The experiences of patients with non-Hodgkin's lymphoma.

AIMS AND OBJECTIVES: To explore the lived experiences of patients on receiving a diagnosis of non-Hodgkin's lymphoma. BACKGROUND: Persons with non-Hodgkin's lymphoma are often diagnosed with cancer when at an advanced stage. This may arise due to a lack of screening programmes and delays in help seeking as the symptoms experienced are fairly nonspecific in nature. Consequently, receiving an unexpected diagnosis of non-Hodgkin's lymphoma may pose a psychosocial challenge to the individual. DESIGN: An exploratory qualitative phenomenological design was used. METHODS: Six adult patients diagnosed with non-Hodgkin's lymphoma were recruited and participated in two semi-structured interviews at different timepoints. Transcribed texts were analysed using interpretative phenomenological analysis. RESULTS: Three main themes emerged: "Emotional reaction to the diagnosis," "Struggling with a lack of understanding" and "Searching through past experiences." Most of the participants expressed shock, disbelief and fear at the news of being diagnosed with non-Hodgkin's lymphoma. A sense of relief was expressed by one participant, who could now provide a label to the pain experienced. CONCLUSIONS: This study highlights the responses of patients with non-Hodgkin's lymphoma on receiving a diagnosis. These responses are influenced by their knowledge about the illness, type of symptoms experienced, their own personal circumstances and the manner in which the diagnosis was given. RELEVANCE TO CLINICAL PRACTICE: Nursing care relates to an understanding of the patients' experiences. By reflecting on these findings, nurses are empowered to communicate with persons who have received a diagnosis of non-Hodgkin's lymphoma in a patient-sensitive manner, which establishes a relationship of trust and respect.

Imbruvica®â–¾(ibrutinib) patient support programme for chronic lymphocytic leukaemia and mantle cell lymphoma.

Single-agent ibrutinib is an effective therapy for three types of non-Hodgkin lymphoma: chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma, both in relapsed and refractory cases and as a frontline treatment; relapsed and refractory mantle cell lymphoma; and Waldenstrom's macroglobulinaemia in patients who have been treated previously with a different medication. This novel agent has changed the landscape for the aforementioned three subtypes of lymphoma therapies as an oral alternative to traditional chemoimmunotherapy. You&i™ is a no-cost support programme, funded by Janssen, that connects patients taking Imbruvica with a nurse who can answer their questions and help address treatment challenges. This programme offers patients information about their disease, their treatment regimen and side effects management by telephone. The You&i programme was tested at an NHS hospital. Case studies of patients and feedback from health professionals who have used this service show its potential benefits to the patient experience and service delivery.

A nurse facilitated mind-body interactive exercise (Chan-Chuang qigong) improves the health status of non-Hodgkin lymphoma patients receiving chemotherapy: Randomised controlled trial.

BACKGROUND: Non-Hodgkin's lymphoma is a heterogeneous group of lymphoproliferative malignancies. Chemotherapy can improve patient survival rates, yet it is also associated with many adverse physical and psychosocial effects. It is suggested that qigong practices may be used to reduce patient distress and side effects. OBJECTIVES: To evaluate the effects of Chan-Chuang qigong on fatigue, complete blood cells, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy. DESIGN: A randomized controlled study. SETTINGS: An oncology ward of medical centre in northern Taiwan. PARTICIPANTS: Fifty participants in each of the two groups. METHODS: Participants were randomly assigned to either the qigong group (n=50) that received a 21-day Chan-Chuang qigong programme, or the control group (n=50). The primary outcome was fatigue measured by Brief Fatigue Inventory. The secondary outcomes were complete blood cell counts, sleep quality measured by Verran and Snyder-Halpern Sleep Scale, and quality of life measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. RESULTS: After 21 days of intervention, the results obtained from ninety six participants were analysed. Participants in the qigong group exhibited decreased fatigue intensity and fatigue interference from 5.49 (SD=1.02) and 5.53 (SD=1.27) to 0.37 (SD=1.39) and 0.20 (SD=1.93), respectively. Generalized estimating equations analyses revealed that the qigong group, when compared to the control group, had significant improvement in fatigue intensity and fatigue interference over time (ß=-1.04, 95% confidence interval [CI] from -1.59 to -0.48, p<0.001; and ß=-1.22, 95% CI from -1.86 to -0.59, p<0.001, respectively). There was a significant between-group difference in the improvement in white blood cell counts (t=5.14, p<0.001), hemoglobin levels (t=3.17, p=0.002), and sleep quality (t=17.73, p<0.001), but not in platelet counts (p=0.05). With regard to quality of life, the scores of the qigong group improved in all subscales and all symptom items when compared to that of the control group. No adverse effects were observed in the qigong group. CONCLUSIONS: The findings of this study indicate that the 21-day Chan- Chuang qigong can reduce fatigue intensity and fatigue interference, and improved white blood cell counts, haemoglobin levels, sleep quality, and quality of life for patients with non-Hodgkin lymphoma who had undergone the first course of chemotherapy. Further studies involving a prolonged extended intervention period and follow-up are necessary for determining the long-term effect of qigong exercise.

Non-Hodgkin's lymphoma.

Essential facts Non-Hodgkin's lymphoma (NHL) is a cancer of the lymphatic system. According to Cancer Research UK, it is the sixth most common cancer in the UK, with 13,413 new cases diagnosed in 2013. There were 4,801 deaths from NHL in 2014. The disease has many subtypes, with two main broad categories: high-grade or aggressive and low-grade or indolent.

Rituximab Faster Infusion for Patients With Non-Hodgkin's Lymphoma in the United States: Implications for Nursing Practice.

The majority of follicular non-Hodgkin's lymphoma patients in the United States receive an initial treatment strategy that includes the infusion of rituximab. Data from a phase III multicenter clinical trial led to the 2012 US Food and Drug Administration approval of a 90-minute infusion of rituximab (Rituxan) starting at Cycle 2 for patients with non-Hodgkin's lymphoma who did not experience a Grade 3 or 4 infusion-related adverse event during Cycle 1. A review of literature was undertaken to identify existing evidence regarding both the safety of rituximab faster infusion and its impact on nursing practice. The aim of this article is to stimulate discussion and lead to implementation of evidence-based nursing practices to improve the delivery of patient care.

Rituximab faster infusion for patients with non-Hodgkin's lymphoma in the United States: implications for nursing practice.

The majority of follicular non-Hodgkin's lymphoma patients in the United States receive an initial treatment strategy that includes the infusion of rituximab. Data from a phase III multicenter clinical trial led to the 2012 US Food and Drug Administration approval of a 90-minute infusion of rituximab (Rituxan) starting at Cycle 2 for patients with non-Hodgkin's lymphoma who did not experience a Grade 3 or 4 infusion-related adverse event during Cycle 1. A review of literature was undertaken to identify existing evidence regarding both the safety of rituximab faster infusion and its impact on nursing practice. The aim of this article is to stimulate discussion and lead to implementation of evidence-based nursing practices to improve the delivery of patient care.

The relationship between learned resourcefulness and cancer-related fatigue in patients with non-Hodgkin lymphoma.

PURPOSE/OBJECTIVES: To investigate the effect of learned resourcefulness on fatigue symptoms in patients with non-Hodgkin lymphoma (NHL) receiving chemotherapy. DESIGN: Quasi-experimental with repeated measures. SETTING: Two large hospitals in Israel. SAMPLE: 46 patients with NHL. METHODS: On the first day of a cycle of chemotherapy treatment, participants completed questionnaires assessing fatigue and learned resourcefulness. Fatigue was assessed again after 10 and 21 days. MAIN RESEARCH VARIABLES: Cancer-related fatigue, learned resourcefulness. FINDINGS: Fatigue increased 10 days following chemotherapy treatment and returned to pretreatment levels at day 21. Learned resourcefulness correlated negatively with each of the three measurements of fatigue. In addition, a calculated partial correlation showed the specific effect of learned resourcefulness on chemotherapy-related fatigue. CONCLUSIONS: The findings showed a negative correlation between a physiologic variable (fatigue) and a psychological variable (learned resourcefulness), which is related to individual coping ability. IMPLICATIONS FOR NURSING: Nurses should receive education about learned resourcefulness to potentially help patients with cancer cope with chemotherapy-related fatigue. KNOWLEDGE TRANSLATION: As learned resourcefulness was negatively correlated with chemotherapy-related fatigue in patients with NHL, having this personality trait may help those patients manage fatigue.

Demographic and disease characteristics associated with non-hodgkin lymphoma survivors' quality of life: does age matter?

PURPOSE/OBJECTIVES: To examine demographic and disease characteristics by age and the moderating effect of age on quality of life (QOL) among non-Hodgkin lymphoma (NHL) survivors. DESIGN: A cross-sectional, secondary analysis study of NHL survivors. SETTING: Two North Carolina cancer registries. SAMPLE: 741 NHL survivors with a mean age of 62 years and a mean time since diagnosis of 10 years. METHODS: Mailed surveys were sent to individuals treated for NHL. All analyses were conducted using SPSS®, version 18.0. Multiple regression was used to analyze relationships among demographic and disease characteristics, age, and QOL. MAIN RESEARCH VARIABLES: Demographic, disease, and clinical characteristics on QOL. FINDINGS: In relation to QOL, income and gender were moderated by age; for example, younger survivors who earned less than $30,000 annually had a poorer QOL. Women reported a higher QOL than men. CONCLUSIONS: Age was a moderator for income and an indicator for how income could affect care of younger survivors. Men reported a lower QOL than women and gender-specific resources may be helpful to them. IMPLICATIONS FOR NURSING: Nursing research should focus on age-sensitive resources targeted for younger NHL survivors. KNOWLEDGE TRANSLATION: Age is an important characteristic that impacts overall health-related QOL. Oncology nurses are instrumental in identifying patients at all ages who could benefit from age-specific resources.

Intervenciones de enfermería en la atención del adulto con linfoma no hodgkin folicular (LNHF) / Nursing interventions in adult attention with Follicular Non-Hodgkin lymphoma (LNHF)

Introducción: Esta guía pone a disposición del personal de enfermería que labora en unidades médicas de tercer nivel de atención, las recomendaciones basadas en la mejor evidencia disponible para la toma de decisiones clínicas, las intervenciones de enfermería en la atención del adulto con Linfoma no Hodgkin Folicular. Método: Se realizó una búsqueda y revisión sistemática en la base de datos de PubMed, sitios específicos de Guías de Práctica Clínica y la biblioteca Cochrane; publicados entre 2002 y 2012, de los cuales se seleccionaron las fuentes con mayor puntaje obtenido en la evaluación de su metodología y las de mayor nivel en cuanto a gradación de evidencias y recomendaciones. Resultados: En la revisión sistemática fueron seleccionados 19 documentos para la elaboración de la guía. Se recomienda al profesional de enfermería fomentar la valoración del paciente identificando las necesidades físicas y emocionales del paciente y de la familia. Las intervenciones deben ser dirigidas antes, durante y después del tratamiento con enfasis en los cuidados de los efectos secundarios de la quimioterapia.Conclusiones: La incorporación de las recomendaciones en la práctica asistencial de enfermería podrá favorecer en la limitación del daño, disminución de comorbilidad y mejora en la calidad de vida en los pacientes mayores de 18 años con linfoma no Hodgkin folicular.

Introduction: This guide provides nursing staff working in medical units tertiary care recommendations based on the best evidence available for clinical decision making, nursing interventions in the care of adults with follicular Non-Hodgkin lymphoma.Method: A search and systematic review was performed in the PubMed database, specific sites Clinical Practice Guidelines and the Cochrane Library; were published between 2002 and 2012, of which the sources were selected with the highest score obtained in the evaluation of its methodology and higher level as to grading evidence and recommendations.Results: In the systematic review they were selected 19 documents for the development of the guide. It is recommended to encourage nurse patient assessment identifying the physical and emotional patient and family needs. Interventions should be directed before, during and after treatment with emphasis on the care of the side effects of chemotherapy.Conclusions: The incorporation of the recommendations in the nursing care practice may favor in limiting the damage, decreased morbidity and improved quality of life in patients over 18 years with follicular non-Hodgkin Lymphoma.

Introdução: Este guia fornece a equipe de enfermagem que trabalham em unidades médicas terciárias cuidar recomendações baseadas na melhor evidência disponível para a tomada de decisão clínica, intervenções de enfermagem no cuidado de adultos com Linfoma folicular não-Hodgkin.Método: Uma pesquisa e revisão sistemática foi realizada no banco de dados PubMed, sites específicos diretrizes de prática clínica e da Biblioteca Cochrane; foram publicados entre 2002 e 2012, dos quais as fontes foram selecionados com a maior pontuação obtida na avaliação de sua metodologia e nível superior quanto à classificação de evidências e recomendações.Resultados: Na revisão sistemática foram selecionados 19 documentos para o desenvolvimento do guia. Recomenda-se a incentivar a enfermeira avaliação do paciente identificar as necessidades físicas e emocionais do paciente e da família. As intervenções devem ser dirigidos antes, durante e após o tratamento com ênfase no cuidado dos efeitos colaterais da quimioterapia.Conclusões: A incorporação das recomendações na prática de cuidados de enfermagem pode favorecer em limitar os danos, diminuição da morbidade e melhor qualidade de vida em pacientes com mais de 18 anos com linfoma não-Hodgkin folicular.

'Being a Part of Treatment': the meaning of self-monitoring for rural cancer patients.

BACKGROUND: The diagnosis and treatment of cancer entail managing vast amounts of information in order for patients to participate effectively in disease self-management. Information management includes patients' responses to acquire, manage, and use external and internal information, such as through self-monitoring practices. OBJECTIVE: The study objective was to examine the meaning of self-monitoring practices within the context of rural patients' responses to internal and external information. METHODS: An empirical phenomenological approach was used. Participants were adults 18 years or older, who were once diagnosed with cancer, who agreed to discuss health monitoring behavior in relation to their cancer experience, and who used services at a small, rural cancer center. Data were collected using semistructured interviews. RESULTS: Findings revealed a self-directed pursuit of self-monitoring that was shaped by 4 factors, that is, cognitive, affective, interpersonal, and symptomatic. Quotations from participants illustrate these factors. "I'd ask the questions …" represents the cognitive factor. "Are the horse stories about cancer treatments true?" represents the affective factor. The interpersonal factor is represented as "My nurse was there for me!" The symptomatic factor is represented as "Chemotherapy blocks out your memory." Informed by these factors, participants' self-monitoring practices fostered participants' sense of control and self-advocacy efforts. CONCLUSION: Nurses are in a strategic position to engage in supportive care practices through the facilitation of self-monitoring. IMPLICATIONS FOR PRACTICE: Assessment questions grounded in study findings are suggested for use by nurses to develop patient-centered education that facilitates self-monitoring practices.

Experiences prior to diagnosis of non-Hodgkin lymphoma: a phenomenological study.

AIM: This paper is a report of a study identifying and describing the essences of patients' experience during the period leading up to the diagnosis of non-Hodgkin lymphoma. BACKGROUND: Patient and doctor delays occur during diagnosis of non-Hodgkin lymphoma, and families can affect patients' help-seeking behaviours. Current guidelines state the need for immediate referral of patients with suspected non-Hodgkin lymphoma symptoms. METHODS: A phenomenological approach was used. A purposive sample of 31 patients diagnosed with non-Hodgkin lymphoma was recruited through a hospital and a support group in the United Kingdom. In-depth interviews were tape-recorded, transcribed and then analysed using Colaizzi's method. Data collection took place over an 18-month period during 2003-2005 and data analysis was completed in 2006. FINDINGS: The overriding theme was: Creating a pathway towards hearing the diagnosis of non-Hodgkin lymphoma. The three themes were as follows: Perceiving individual health and onward movement; Penetrating communication processes and investigations; Advancing towards focusing on the non-Hodgkin lymphoma diagnosis. Patients with non-Hodgkin lymphoma can have a diverse symptom presentation over long periods of time. Their help-seeking behaviours are an interplay of essences, including symptom type, attributions and emotional responses. Patients need tailored information to deal with the uncertainty of their situation at key points during their prediagnosis journey. CONCLUSION: Nurses should help patients identify and acquire the appropriate information at key points during the diagnosis period as this is a period of great uncertainty. Further research should be conducted into the quality of prediagnosis consultations and the extent to which patients think that their agendums have been met at this time.

Managing neutropenia in older patients with cancer receiving chemotherapy in a community setting.

Older patients with cancer who may be more susceptible than younger patients to the myelosuppressive effects of chemotherapy undergo dose delays and reductions that can compromise treatment outcomes. Incidence of neutropenic complications and suboptimal chemotherapy delivery can be reduced with prophylactic colony-stimulating factors; however, their use in older patients with cancer has not been well studied. A randomized, multicenter, community-based trial was designed to compare prophylactic pegfilgrastim use (all cycles of chemotherapy) versus its more common reactive use (at clinicians' discretion) in patients aged 65 years or older with various cancers. Pegfilgrastim use in all cycles reduced the incidence of febrile neutropenia by about 60% and hospitalizations caused by neutropenia and febrile neutropenia by about 50% versus reactive pegfilgrastim use in later cycles. The study showed that older patients with cancer can be treated safely with optimal doses of chemotherapy with appropriate supportive care. Nurses, key collaborators in providing supportive care, can take an active role in identifying older patients who may benefit from pegfilgrastim in all cycles of chemotherapy.

Treatment approaches and nursing applications for non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL), a malignancy that manifests in the lymphatic system, is one of the most commonly occurring hematologic disease types in the United States and other Westernized countries. NHL is divided into a range of subtypes with differing clinical features and outcomes. Depending on the type of NHL and the patient's overall clinical presentation, treatment varies from systemic combined chemotherapy regimens with or without immunotherapy, radioimmunotherapy, and transplants to investigational options. Oncology nurses play a vital role in implementing successful treatment and management of patients with NHL as oncology care moves into an era of novel targeted therapies.

High-dose methotrexate and primary central nervous system lymphoma.

Primary central nervous system lymphoma (PCNSL) is a rare disease that is managed differently from other primary brain tumors and other types of systemic lymphomas. The use of high-dose methotrexate (HD-MTX) has improved survival rates. This article describes the experience of a patient treated with HD-MTX and outlines the essential aspects of care for the bedside practitioner. An understanding of the diagnostic workup and principles of treatment can minimize complications and maximize patient function as nurses care for the unique physical and emotional needs of this population.

Radioimmunotherapy for non-Hodgkin's lymphoma.

OBJECTIVES: To describe the rationale for radioimmunotherapy as a treatment of non-Hodgkin's lymphoma. To present the similarities and differences in the two radioimmunotherapies and the nursing implications in caring for patients receiving these agents. DATA SOURCES: Published literature and review of published clinical trials. CONCLUSION: Radiolabeled monoclonal antibodies bind to specific antigens and provide a means of targeting tumor cells with cytotoxic radioactivity. The infusion of radiolabeled monoclonal antibodies requires an understanding of antibody therapy, radiation therapy, and principles of time, distance, and shielding. IMPLICATIONS FOR NURSING PRACTICE: As the use of radioimmunotherapy grows, nurses must be aware of the background for, logistics of, and follow-up required for patients receiving this form of radiation treatment.

Dose-dense chemotherapy for aggressive non-Hodgkin lymphoma.

Non-Hodgkin lymphoma is a heterogeneous disease that represents the seventh leading cause of cancer death. Second-generation and third-generation chemotherapy regimens have only produced a marginal improvement in outcome over the administration of the cyclophosphamide, doxorubicin, vincristine, and prednisone regimen in aggressive forms of non-Hodgkin lymphoma. This has led to the development of different strategies for improving disease-free and overall survival in this disease. Dose intensification achieved by condensing the intervals between each chemotherapy cycle is possible with granulocyte colony-stimulating factor support, which reduces neutropenia and its complications. Clinical trials indicate that this strategy may improve the outcomes in patients with aggressive non-Hodgkin lymphoma, particularly elderly patients. Nurses can play a major role in the implementation of evidence-based supportive care strategies in clinical practice to ensure safe use of dose-dense chemotherapy regimens.

Overview of non-Hodgkin's lymphoma.

OBJECTIVES: To provide an overview of non-Hodgkin's lymphoma (NHL). DATA SOURCES: Review and research articles. CONCLUSION: NHLs are divided primarily into two main categories based on their rate of growth: aggressive and indolent. Within these two groups are various subtypes that have various clinical features. Prognostic features have been useful in determining the potential outcome of treatment of patients with NHL. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an important role in the education of patients regarding the type of lymphoma they have and the steps necessary to make an accurate diagnosis, which is important in determining the appropriate treatment.