Protocol for Care After Lymphoma (CALy) trial: a phase II pilot randomised controlled trial of a lymphoma nurse-led model of survivorship care

INTRODUCTION

Lymphoma is the sixth most common cancer diagnosed in Australia and internationally. Owing to the aggressive nature of the disease and intensity of treatment, survivors face long-term effects that impact on quality of life. Current models of follow-up post-treatment fail to address these complex issues. Given that 74% of patients with lymphoma cancer now survive 5 years beyond diagnosis and treatment, it is important to address this gap in care.

AIM

To determine self-reported informational and practical needs, anxiety, depression, stress, coping and empowerment at baseline, 3 and 6 months.

METHODS AND ANALYSIS

A pilot randomised controlled trial will test the effect of a nurse-led lymphoma survivorship clinic compared with usual post-treatment care at a large tertiary cancer centre in Western Australia. The intervention will comprise three face-to-face appointments with delivery of tailored resources, a survivorship care plan and treatment summary (SCP TS). The SCP TS will be given to the participant and general practitioner (GP). Intervention participants will be interviewed at completion to explore the perceived value of the intervention components and preferred dose. An evaluation developed for GPs will assess receipt and use of SCP TS. The primary intent of analysis will be to address the feasibility of a larger trial and requisite effect and sample size.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the University of Notre Dame Australia and Sir Charles Gairdner Hospital in Western Australia. Peer-reviewed publications and conference presentations will report the results of this phase II trial.

TRIAL REGISTRATION NUMBER

ANZCTRN12615000530527; Pre-results.

On the right track

The outlook for people with lymphoma is improving as research has increased knowledge of the disease and effective methods to treat it.

Lymphoma network

While some cancers get a great deal of media coverage, lymphoma is something of the poor relation, although there are about 11,000 new cases a year in the UK. Gill Woods has taken on the role of the first clinical nurse specialist in lymphoma to help patients understand their condition.

Looking at lymphoma and leukemia

Learn the signs and symptoms of these liquid tumors and how to help patients manage them.

Help patients cope with chemo

Chemotherapy is keeping more and more patients alive, but its side effects can be debilitating. Appropriate nursing care and education can help cancer patients overcome the challenges of this vital treatment.

Lymphedema management in patients with lymphoma

Lymphoma and its treatments put patients at risk for lymphedema. The effect of lymphedema and its treatments on quality of life has been studied in other populations, but not in patients with lymphoma. Treatment effectiveness is poorly documented and confusion surrounding lymphedema therapy creates barriers to care. Reimbursement issues and the paucity of therapists limit access to care. Nursing research, care and collaboration with lymphedema therapists directly impacts the quality of lymphedema care for patients with lymphoma. Lymphedema pathology and treatments are described and recommendations are made for nursing care and research.

Gastric cancer

OBJECTIVES

To review the current status, recent advances, and ongoing research related to screening, diagnosis, staging, and treatment of gastric cancer.

DATA SOURCES

Professional journals, research studies, and review articles relating to gastric cancer.

CONCLUSIONS

Surgical resection is the gold standard curative treatment for gastric cancer; however, diagnosis is often at later stages of disease, leaving poor long-term survival rates. An emphasis has been placed on developing more effective chemotherapy regimens; currently, fluorouracil is the standard single agent used for gastric cancer. Radiation therapy has been used for palliative symptom management.

IMPLICATIONS FOR NURSING PRACTICE

An understanding of current treatment modalities for gastric cancer will help oncology nurses assist their patients throughout their course of treatment with education, nutritional support, and symptom control.

The molecular biology of lymphoma

OBJECTIVES

To review the current state of knowledge of the molecular biology of lymphoma, the clinical relevance of findings, and the implications for practice.

DATA SOURCES

Published research articles, proceedings of conferences, and oncology textbooks.

CONCLUSIONS

The molecular biology of lymphomas has been the subject of many research studies in the past two decades. New cytogenetic techniques have led to a wealth of information on lymphomagenesis and its impact on the diagnosis, prognosis, and management of lymphoma, which will continue into the next decade.

IMPLICATIONS FOR NURSING PRACTICE

An understanding of the molecular biology of lymphoma will assist cancer nurses in providing current, state-of-the-art patient education and will facilitate an understanding of newly developed methods in the prognosis and treatment of this malignancy.

Lymphoma at the extremes of age

OBJECTIVES

To provide a review of the unique features of both Hodgkin's and non-Hodgkin's lymphoma in pediatric and geriatric patient populations. Treatment approaches and nursing care interventions at the extremes of age will be discussed.

DATA SOURCES

Review articles, research studies, and book chapters.

CONCLUSIONS

Lymphoma is a highly heterogeneous malignancy whose classification and management have undergone significant evolution. Of particular concern has been lymphoma's prevalence and treatment at the extremes of age. Appropriate treatment by age and subtype remains controversial.

IMPLICATIONS FOR NURSING PRACTICE

The nursing care of pediatric and geriatric patients with lymphoma presents numerous challenges in education, symptom management, and supportive care.

Oncologic emergencies in the patient with lymphoma

OBJECTIVES

To provide a brief overview of the oncologic emergencies most commonly occurring in lymphoma patients.

DATA SOURCES

Published articles, research studies, and reference books.

CONCLUSIONS

As a result of their malignancy and the treatments they receive, lymphoma patients are at an increased risk for the development of the following oncologic emergencies: superior vena cava syndrome, cardiac tamponade, sepsis, acute tumor lysis syndrome, and increased intracranial pressure. If not recognized and treated quickly, these complications can be deadly. With appropriate medical and nursing management, these emergencies either can be prevented or their complications minimized.

IMPLICATIONS FOR NURSING PRACTICE

An awareness of which patients are at risk for these complications and the pathophysiology of each emergency will assist nurses in the implementation of treatment measures.

Lymphomas: long-term sequelae and survivorship issues

OBJECTIVES

To provide a review of long-term sequelae of lymphoma and its treatment, with emphasis on second malignancies, survivorship issues, rehabilitation, and quality of life.

DATA SOURCES

Review articles, research studies, and book chapters pertaining to late effects of treatment of lymphomas and to rehabilitation and quality of life for survivors of Hodgkin's disease or non-Hodgkin's lymphoma.

CONCLUSIONS

Overall, the outlook for survivors of the lymphomas is positive. The risk of developing second malignancies as long-term sequelae, although relatively low, and the need for physical and psychological health maintenance, warrant lifetime follow-up and support.

IMPLICATIONS FOR NURSING PRACTICE

Nurses have a key role in preparing patients for survivorship. By fostering a philosophy and program of rehabilitation that begins at the time of diagnosis, nurses can assist survivors of lymphoma to achieve quality of life.

Spouses' view during their partners' illness and treatment

Nine spouses of people who had suffered from acute leukemia or highly malignant lymphoma were interviewed about their everyday life experiences throughout their partner's illness and treatment, and concerning their view of the professional care provided. The transcribed texts were subjected to phenomenological-hermeneutic analysis. The spouses felt they were in a situation of overall severe crisis (i.e., experiencing feelings of distress, restrictions, and limited or lack of support). The analysis revealed three family types: the couple acting as a unit, the couple acting independently on equal terms, and the couple acting separately with the spouse in a subordinate position. The spouses' evaluation of the entire experience varied according to the family type and the spouses' personal resources, which influenced the availability and utilization of their social network as well as the support of health-care staff. Contentment was related to the couple acting as a unit or the couple acting independently on equal terms and taking control over the situation, actively asking for support and requiring the staff to meet their needs. Discontentment was related to subordination of the spouse to the partner or to health-care staff, and failure of the couple to obtain support between them or from others. Empowering the spouses may mean helping them develop their skills, providing them with opportunities and authority, and assisting them in gaining access to resources based on knowledge of the family type, the consent of the partner, and the spouse's freedom to make choices. This may well lead to increased efficiency and have positive effects for the patient, for the spouse, and for them both as a couple.

Lymphoma

Lymphomas are rare tumors, which can be unilateral or bilateral. Lymphomas may affect the conjunctiva, the eyelid, and the orbit; and they may be diagnosed systemically. Ophthalmic nurses are the perfect health care professionals to educate and provide the care for these patients. An interesting patient who was diagnosed with a lymphoma is presented.

Critical care of the patient with hematologic malignancy

Patients with leukemia, lymphoma, or multiple myeloma are prone to critical illness because of the diffuse nature of their disease and the disruption of protective mechanisms. Despite high morbidity rates, a number of these patients have an excellent probability of long-term remission if supported through a crisis. Complications that cause critical illness can be categorized as related to disease or those caused by therapy. Those with unique features or management strategies for the hematologic malignancy patient and are included in this discussion include: leukostasis, disseminated intravascular coagulation, tumor lysis syndrome, respiratory failure, and typhlitis. A case study of an acutely ill, newly diagnosed patient with several of these oncologic emergencies is used to exemplify typical clinical finds and management strategies.

Supporting one another: the nature of family work when a young adult has cancer

Families, and the support they provide, are one of the most important resources of the informal health care delivery system. As nurses we are called upon to enable clients to maximize their use of family resources and to enable families to cope with illness-related events. While research has clearly documented the important role of support in enabling persons to cope effectively with illnesses and illness-related events, further research to understand the processes of providing support within families has been called for. With such information we may be more effective in our efforts to guide and support families as they cope with illness in a family member. This paper was developed from a qualitative study with young adults with cancer that examined social relationships in order to understand the nature of interactions perceived as supportive and the context within which they occurred. In-depth interviews conducted with young adults provided detailed data regarding the nature of support young adults received from and offered to their families in order to maintain family functioning. The processes of offering and receiving support have been conceptualized into five categories of 'family work'. The nature of the work is described and the roles of family members in accomplishing the work are addressed. The findings are discussed in relation to current issues in practice.

Neurologic manifestations of AIDS

Patients with AIDS constantly challenge clinicians with the diversity of diseases that are seen, but also in the many ways they present. Neurological presentations are common in AIDS patients, although a systematic, detailed investigation is essential to distinguish opportunistic disease from the other causes of neurological dysfunction. These neurological complications are the second most frequent cause of death in AIDS patients. Nurses must have a solid knowledge base regarding AIDS and its neurologic manifestations. Skillful management of the numerous physical complications is necessary for accurate assessment and successful treatment. Despite the many debilitating effects of these syndromes and the grim proposals, there are many opportunities to stabilize patients physically and emotionally so that they may have as normal and successful lives as possible.