The evidence-based recommendations described below outline the standard follow-up procedures for Indolent Non-Hodgkin Lymphoma surveillance and are intended to assist you in providing optimal cancer follow-up care for your patient; these recommendations are not intended to be a substitute for clinical judgement.
As part of the minimum recommended follow-up, the patient's primary care provider is asked to organize:
| Frequency | 2-5 Years Since Treatment Completion | 5+ Years Since Treatment Completion |
|---|---|---|
| Every 6 months until 5 years post-treatment |
|
- |
| Annually |
|
|
Primary malignancies are more common in survivors of iNHL, especially non-melanoma skin cancers. All other secondary cancer screening should be according to standard practice.
Monitor for Relapse: During the clinical exam, careful attention should be paid to lymph nodes.
Abnormal Lymphadenopathy includes:
Monitor for Progressive Splenomegaly.
Routine CT scanning is not recommended for asymptomatic patients who have been treated for lymphoma. Radiological imaging is recommended for patients with new symptoms or with new or enlarging lymphadenopathy.
Indolent lymphomas may relapse years or decades after prior remission. If a new lymph node is noted after discharge from cancer care, this would likely not be an emergency but should be communicated back to the cancer center or treating oncologist.
Please be aware of these potential symptoms of iNHL recurrence:
Patients should be referred back to their treating oncologist. If the oncologist's contact information is not available, please search "lymphoma" in the Alberta Referral Directory for the most up-to-date information and instructions for referral.
During each clinical visit, patients should be reviewed for complications related to their treatment.
Dental caries are a risk for patients who received neck or oropharyngeal radiation due to decreased salivation. Patients should have regular dental follow-up and make their dentist aware of the radiation treatment.
Patients who received thyroid radiation are at risk for hypothyroidism. Patients with elevated TSH levels should be treated with lifelong T4 replacement. Patient with clinical hypothyroidism should be treated with lifelong thyroid replacement.
Chemotherapy and mediastinal or neck radiation therapy may cause cardiac and cerebrovascular dysfunction/disease. Patients should be counselled about modifiable risk factors such as body weight, physical activity, smoking, diabetes, and nutrition. Please contact the Cardio-Oncology Clinic if your patients have concerns related to cardio-oncology.
Hypertension and hypercholesterolemia should be aggressively managed if present.
The table below outlines some other common general complications of cancer treatment:
| Complication | Treatment-Related Causes | Actions |
|---|---|---|
| Fatigue |
|
Fatigue should start to improve within months of treatment completion. Persistent or recurrent fatigue warrants further work-up to rule out other potential causes. |
| Peripheral Neuropathy |
|
Peripheral neuropathy should improve over months. |
| Lymphedema |
|
Early symptoms include leg heaviness or discomfort and may be present with/without overt swelling. Referral to local rehabilitation services (e.g. physiotherapy) or lymphedema clinic can be made. More information can be found in the lymphedema resource. |
| Psychosocial Distress |
|
Increasing helplessness/hopelessness, distress, anxiety or depression may be present. Patients experiencing these symptoms should be encouraged to inform their oncology treatment team for appropriate psychosocial referral. More information about fear of recurrence can be found in the FCR resource. |
| Menopausal Symptoms |
|
Some patients will experience new symptoms of menopause after treatment. |
Potential for Relapse
Indolent lymphomas may relapse years or decades after prior emission.
Monitor for new enlarged lymph nodes after discharge from the cancer center and refer back to the treating oncologist if new nodes are detected.
Secondary Malignancies
iNHL patients are at increased risk for secondary cancers, including thyroid, breast, lung, upper GI, AML, melanoma, and cervical cancer.
Screening as appropriate is indicated (e.g. mammogram and Pap tests).
Patients should be counselled about the risks of smoking and excessive UV exposure, encouraged to perform skin self-exams, and advised to report any suspicious symptoms to their physician.
Sexual Health
Treatment for lymphoma can impact your patient's gonadal function and fertility. Assessments (e.g. testosterone, LH, FSH) should be based on symptoms.
Referral to a sexual health expert and/or fertility specialist is warranted if your patient has concerns with sexual function, health, relationships, and sometimes distress over body image.
The Oncology and Sexuality, Intimacy, and Survivorship (OASIS) program assists patients to manage physical and emotional concerns.
More information about sexual health and the OASIS program is found in the Indolent Non-Hodgkin Lymphoma Transfer of Care Physician Letter.
Note: The information on this page was adapted from the AHS Guideline Resource Unit's Lymphoma Guideline, and the accompanying Indolent Non-Hodgkin Lymphoma Transfer of Care Physician Letter. Also available is the Indolent Non-Hodgkin Lymphoma Transfer of Care Patient Letter.
