End of Life Stages in Lymphoma Cancer
There are more than 70 different kinds of lymphoma, a cancer of the immune cells 1. As such, the path from diagnosis to the end of life can vary quite a bit. Hodgkin lymphoma is very curable, while some non-Hodgkin lymphomas are more difficult to treat 48. Stage IV lymphoma is the most advanced, but this can mean very different things for different people -- including living a fulfilling life for many years, in some cases. If the disease does progress toward the end of life, people go through stages that include changing the focus of therapy, emphasis on quality of life and symptom control, and providing support and comfort up to the last day of life.
Changing Focus
More aggressive stage IV or recurrent lymphoma often requires more intensive treatment, such as stem cell transplantation with high-dose chemotherapy. Doctors use a variety of tools to help people with cancer balance the risks and potential gains from anti-cancer therapy. People react differently to a poor prognosis, but some decide to focus on quality of life and maximizing the fullness of their remaining days rather than continuing with anti-cancer therapies.
Continuing Care
What to Expect in the Last Stage of Cancer
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Continuing care focuses on preserving the quality of a person's life, rather than prolonging it, but this does not mean giving up. Many people don't realize that the final process of dying is relatively short, occurring over just a few days. Until a person enters this phase, life can be close to normal -- although the person is obviously sick, with fatigue being very common. A pain-management plan developed by specialists can enable individuals to live their final days comfortably. As the end of life draws near, some people opt for home care by loved ones, while others prefer hospice care, which draws on the support of people who have both medical training and, oftentimes, considerable experience with end-of-life issues.
- Continuing care focuses on preserving the quality of a person's life, rather than prolonging it, but this does not mean giving up.
- As the end of life draws near, some people opt for home care by loved ones, while others prefer hospice care, which draws on the support of people who have both medical training and, oftentimes, considerable experience with end-of-life issues.
Changes in Body Function
As lymphoma spreads throughout the body, therapies that were previously used to treat the cancer may be used as a means of controlling symptoms 1. For example, if lymphoma spreads to the bones, radiation may be used to relieve pain. Chemotherapy may be advantageous in shrinking distant tumors that are blocking the function of organs, such as the bowels. Organs containing tumors may eventually fail to function properly, which can lead to such problems as difficulty breathing or swallowing, diminished mental capacity, infections, pain or fatigue.
- As lymphoma spreads throughout the body, therapies that were previously used to treat the cancer may be used as a means of controlling symptoms 1.
- Chemotherapy may be advantageous in shrinking distant tumors that are blocking the function of organs, such as the bowels.
Support and Preparation
Hospitalization Vs. Hospice Care
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Despite advances in medicine, unpredictable events and complications -- like infections -- can make it very difficult for doctors to say for sure when a person will live his last day. This unpredictability in the timing of death makes it important to have final arrangements well planned early on. Making personal decisions ahead of time and setting up a strong support network will optimize the time remaining for an individual to share with loved ones.
Related Articles
References
- National Cancer Institute: Lymphoma
- National Cancer Institute: Adult Hodgkin Lymphoma Treatment
- National Cancer Institute: Adult Non-Hodgkin Lymphoma Treatment
- Cancer.net: Lymphoma – Non-Hodgkin: Stages
- American Cancer Society: Cancer Facts & Figures 2015
- Cancer Research UK: Statistics and Outlook for Non Hodgkin Lymphoma
- American Cancer Society: Making End-of-Life Decisions
- American Cancer Society: If Treatment for Non-Hodgkin Lymphoma Stops Working
- Canadian Virtual Hospice: What Can Be Expected With Non-Hodkin’s Lymphoma?
- American Cancer Society: Choosing Hospice Care
- Maggioncalda A, Malik N, Shenoy P, et al. Clinical, Molecular, and Environmental Risk Factors for Hodgkin Lymphoma. Adv Hematol. 2011;2011;736261. doi:10.1155/2011/736261
- Horesh N, Horowitz NA. Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy. Rambam Maimonides Med J. 2014 Oct;5(4):e0038. doi:10.5041/RMMJ.10172
- Klimm B, Franklin J, Stein H, et al. Lymphocyte-Depleted Classical Hodgkin's Lymphoma: A Comprehensive Analysis From the German Hodgkin Study Group. J Clln Oncol. 2011 Oct;29(29):3914-20. doi:10.1200/JCO.2011.36.4703
- Brücher BLDM, Jamall IS. Somatic Mutation Theory: Why it's Wrong for Most Cancers. Cell Physiol Biochem. 2016;38:1663-80. doi:10.1159/000443106
- Freedman AS, Jacobson CA, Mauch P, Aster JC. Chapter 103: Non-Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology (10th ed). Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2015.
- Ewers EC, Sheffler RL, Wang J, Ngauy V. Immunoproliferative Small Intestinal Disease Associated with Overwhelming Polymicrobial Gastrointestinal Infection with Transformation to Diffuse Large B-cell Lymphoma. Am J Trop Med Hyg. 2016 May;94(5):1177-81. doi:10.4269/ajtmh.15-0831
- Anderson LA, Atman AA, McShane CM, et al. Common infection-related conditions and risk of lymphoid malignancies in older individuals. Br J Cancer. 2014 May 27;110(11):2796-803. doi:10.1038/bjc.2014.173
- Vockerodt M, Cader FZ, Shannon-Lowe C, Murray P. Epstein-Barr virus and the origin of Hodgkin lymphoma. Chin J Cancer. 2014 Dec;33(12):591-7. doi:10.5732/cjc.014.10193
- Floch P, Mégraud F, Lehours P. Helicobacter pylori Strains and Gastric MALT Lymphoma. Toxins (Basel). 2017 Apr;9(4):132. doi:10.3390/toxins9040132
- Pozzato G, Mazzaro C, Dal Maso L. Hepatitis C virus and non-Hodgkin’s lymphomas: Meta-analysis of epidemiology data and therapy options. World J Hepatol. 2016 Jan;8(2):107-16. doi:10.4254/wjh.v8.i2.107
- Narkhede M, Arora Sh, Ujjani C. Primary effusion lymphoma: current perspective. Onco Targets Ther. 2018;11:3747-54. doi:10.2147/OTT.S167392
- Mehta-Shah N, Ratner L, Horwitz SM. Adult T-Cell Leukemia/Lymphoma. J Oncol Prac. 2017 Aug;13(8):487-92. doi:10.1200/JOP.2017.021907
- Kim CJ, Friedman DM, Curtis RE, et al. Risk of non-Hodgkin lymphoma after radiotherapy for solid cancers. Leuk Lymphoma. 2013 Aug; 54(8). doi:10.3109/10428194.2012.753543
- Bertrand A, Giovannucci E, Rosner BA, et al. Dietary fat intake and risk of non-Hodgkin lymphoma in 2 large prospective cohorts. Am J Clin Nutrition. 2017 Aug;106(2):650-6. doi:10.3945/ajcn.117.155010
- Ghione P, Cordeiro PG,Ni A, Hu Q. Risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3,546 women prospectively followed after receiving textured breast implants. J Clin Oncol. 2019 May;37(Suppl 15):1565. doi:10.1200/JCO.2019.37.15_suppl.1565
- Clemens MW, Horowitz SM. NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Large Cell Lymphoma. Aesthetic Surg J. 2017;37(3):285-9. doi:10.1093/asj/sjw259
- Cerhan JR, Slager SL. Familial predisposition and genetic risk factors for lymphoma. Blood. 2015 Nov;126(20):2265-73. doi:10.1182/blood-2015-04-537498
- Navaranjan G, Hohenadel K, Blair A, et al. Exposures to multiple pesticides and the risk of Hodgkin lymphoma in Canadian men. Cancer Causes Control. 2013;24(9):1661-73. doi:10.1007/s10552-013-0240-y
- Scholz M, Engert A, Franklin J, et al. Impact of first- and second-line treatment for Hodgkin's lymphoma on the incidence of AML/MDS and NHL: Experience of the German Hodgkin's Lymphoma Study Group analyzed by a parametric model of carcinogenesis. Ann Oncol. 2011 Mar;22(3):681-8. doi:10.1093/annonc/mdq408
- Smedby KE, Vajdic CM, Falster M, et al. Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the InterLymph Consortium. Blood. 2008;111:4029-4038. doi:10.1182/blood-2007-10-119974
- Spinelli JJ, Ng CH, Weber JP, et al. Organochlorines and risk of non-Hodgkin lymphoma. Int J Cancer. 2007 Dec 15;121(12):2767-75. doi:10.1002/ijc.23005
- Strongman H, Brown A, Smeeth L, Bhaskaran K. Body mass index and Hodgkin's lymphoma: UK population-based cohort study of 5.8 million individuals. Br J Cancer. 2019;120:768-70. doi:10.1038/s41416-019-0401-1
Writer Bio
Molly Jenkins is a medical writer with a PhD in biomedical sciences. Jenkins has published many scientific research articles and reviews as well as clinical newsletters.