This information is for patients with either: Diffuse large B-cell lymphoma (DLBCL) receiving R-CHOP or R-Pola-CHP chemotherapy or Classical Hodgkin lymphoma receiving ABVD or scBEACOPDac chemotherapy
Introduction
The treatment you are receiving in the form of chemotherapy is with the intention of permanently curing the type of lymphoma you have been diagnosed with so that it does not return in the future.
Many people with this type of lymphoma do extremely well with treatment, but unfortunately in some cases the lymphoma does not respond as well to treatment as hoped, or may initially respond but then recurs at a later stage. This is why we follow you up closely during your treatment and also why we continue to review you in clinic for two years after completing treatment.
We know that almost all instances of relapse of this type of lymphoma will occur within two years of completing treatment and that the chance of relapse after that time is very slim.
We also know that bringing people back to clinic routinely after two years can do more harm than good by fuelling anxiety and by providing a regular reminder of previous treatment when in fact simply getting on with life is the focus by that stage.
After successful completion of chemotherapy and two years of follow up, we would discharge you back to the care of your GP with clear information about what to look out for and how to get back in touch with the lymphoma team.
Pre-chemotherapy Appointment
Its OK to ask?
At this appointment we will talk again with you about your diagnosis and in particular the planned treatment.
You will already have received some written information about your lymphoma and the treatment we have recommended at a prior clinic appointment so you will have had the opportunity to read and think about this information at home in your own time. The pre-chemotherapy appointment is another opportunity for you to ask questions and clarify anything you are not sure of.
You will also receive an appointment for an ultrasound scan of your heart (an echocardiogram) which we do as a routine measure for patients who will be receiving any of the chemotherapy regimens detailed in this leaflet.
Once we have come to a decision with you about your treatment, we would aim to complete the treatment consent form at this appointment so that you are ready to start your chemotherapy shortly after this appointment.
Our chemotherapy department will schedule your appointments for treatment and also a pre-assessment appointment a couple of days before you start treatment to go through some paperwork and ensure you are aware of where to go for treatment and what to expect on the day.
Clinic appointments during chemotherapy
Once you have started your course of chemotherapy – which usually lasts between 4 – 6 months but there can be some variations due to individual circumstances – you will need a blood test and a review by a doctor in clinic prior to each cycle.
For patients receiving either R-CHOP or R-POLA-CHP chemotherapy these blood tests and clinic reviews will be every 3 weeks.
For those receiving ABVD chemotherapy these clinic reviews will be every 4 weeks.
For those receiving escBEACOPDac the reviews will be every 3 weeks but blood tests will be more frequent (approx.. 3 times per week while on chemotherapy).
Most of these reviews will be face to face in the lymphoma clinic but there may be occasions where they are able to do these reviews over the phone with you having your bloods taken in advance of the appointment.
Part way through your treatment (after cycle 3 for R-CHOP and R-POLA-CHP patients and after 2 cycles for ABVD or escBEACOPDac patients) you will have a scan to check the response of your lymphoma to the treatment. You will receive the results of these results in your next clinic appointment.
Scans
Most patients will have a PET CT scan prior to the start of their chemotherapy as well as part way through their treatment to check the response of their lymphoma to the chemotherapy. Depending on the results of your PET CT scan you may also need a scan at the end of your chemotherapy.
Patients do not routinely require scans after completion of their chemotherapy treatment unless there is clear reason such as new symptoms.
The PET CT will take place in the nuclear medicine department on level 1 in Bexley Wing at St James’s University Hospital. You will be contacted by the PET CT department which is run by Alliance Medical to arrange your PET CT. They will inform you of the requirements prior to the scan as you need to fast and if you are diabetic this may also impact on your medication for your diabetes.
You will be given the results of your scan at your next clinic appointment. Due to timings of scans, MDTs and clinics there are a small number of occasions where this result will not be available at the time of your clinic appointment. If this is the case the doctor will arrange for another time for you to be told these results. Please be advised that scan results are not usually given over the phone.
Completion of treatment
Once you have completed your treatment, you and your GP will receive a detailed completion of treatment letter and you will be followed up routinely every 3-4 months in the lymphoma clinic for a further 2 years.
At each clinic appointment we will usually take some blood samples and you will be reviewed by a doctor to check on how you are feeling and if you have had any changes or new symptoms relating to lymphoma. These appointments can either be face to face or over the telephone and over the two years of follow up are likely to be a combination of the two. If the appointment is a telephone review you will be asked to have your bloods taken in advance at either your GP surgery or a hospital phlebotomy room.
After two years of follow up, if all continues to be well, we will discharge you from lymphoma clinic follow up. You and your GP will both receive a discharge from routine follow up letter with information about what to look out for in the future and how to contact us again should you need to do so.
After discharge from the lymphoma clinic you will be offered the opportunity to attend one of the patient education events for advice moving on from your diagnosis and treatment. These sessions are run by the CNS team with Macmillan and the Robert Ogden Centre and are held twice a year.
Useful Contact details
J80 Chemotherapy Suite
J87 Outpatient Department
Lymphoma Clinical Nurse Specialist
Roisin Pawsey (Team Leader)
Lymphoma Clinical Nurse Specialist
Emillie Taynton
Lymphoma Clinical Nurse Specialist
Jacinta Barltrop