A range of supportive care needs result from the effects of the disease and the treatment approaches used in the management of NHL.
Myelosuppression is a common treatment-related effect, and the risk is significantly increased in individuals by age 65.32 It is associated with administration of:7
- alkylating agents
- purine analogs
- radioimmunotherapy agents.
Early interventions are crucial to prevent viral reactivation and infections and include:3, 7, 37
- administration of myeloid growth factors
- administration of antiviral prophylaxis or pre-emptive therapy
- transfusion support
- maintaining neutropaenic precautions
- effective hand-washing techniques
Studies report that the risk of myelosuppression in individuals treated for lymphoma is decreased by 50% when using growth factors. The effective management of myelosuppression is crucial, as evidenced by reported mortality rates of 5% to 30% in individuals aged 70 and over with neutropaenic infections.32
Prophylactic use of granulocyte colony-stimulating factor (G-CSF) has been shown to reduce the incidence, length and severity of chemotherapy-related neutropaenia, reduce the risk of febrile neutropaenia, and improve relative dose intensity of the chemotherapy delivered.37
The indication for prophylactic G-CSF use depends on the risk of febrile neutropaenia or other neutropaenic events which may compromise treatment.37 The main toxicity associated with G-CSF therapy is mild to moderate bone pain which is usually controlled by non-narcotic analgesics.37
Anaemia, associated with lymphoid malignancies and their treatment, is a debilitating adverse effect, contributing to fatigue, reduced quality of life and even poor treatment outcomes and reduced survival. Red blood cell transfusion may be indicated for individuals with Hb in the range of 70-100g/L and is likely when Hb is less than 70g/L.38 Platelets may be also indicated for individuals with thrombocytopaenia. Clinical practice guidelines outline the appropriate prophylactic and therapeutic use of platelets.39
The following resources are recommended for further information on the use of blood components.
- Guidelines for the administration of blood components(PDF, 936KB)39 Australian and New Zealand Society of Blood Transfusion. 2011
- Australian and New Zealand Society of blood transfusion website
- BloodSafe e-learning Australia website
Common gastrointestinal effects include nausea, vomiting and diarrhoea. While these may be managed with pharmacological approaches, the SCN has a key role in assessing individuals to monitor for potential dehydration, electrolyte abnormalities and nutritional deficiencies.7
Alopecia may be caused by administration of alkylating agents and anthracyclines or radiation therapy.7 It has been reported that both men and women find hair loss related to cancer treatment a source of distress, depression and loss of confidence.40 The SCN has a key role in meeting the supportive care needs of people affected by alopecia and making referrals to support services in this area.
Mucositis may be associated with antineoplastic agents and radiotherapy. The severity and incidence of mucositis depends on the treatment regimen.7
Define 'dose intensity' and discuss why it is significant in the management of NHL.
Discuss evidence based interventions to promote early detection of neutropaenic sepsis in a person receiving treatment for NHL.
Discuss the evidence based nursing responses to a person demonstrating signs of neutropaenic sepsis.
Outline the current evidence regarding the following aspects of neutropaenic precautions and compare this evidence to current practice within your health care facility:
- Isolation precaution
- Dietary restrictions.
Explain the mechanisms of action of colony stimulating factors and their role in supportive care for the person with NHL.
Discuss nursing considerations associated with administering colony stimulating factors for the person with NHL.
Outline the indications for transfusion support in the person receiving treatment for NHL.
Explain nursing considerations in administering blood and blood products for the person with NHL.